GRAND LAKE MENTAL HEALTH CENTER, INC. (NPI# 1013925882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013925882 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Other Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC.-AFTON CLINIC |
| Practice Address |
138 S. Main Afton OK 74331 |
| Mailing Address |
114 W Delaware Ave Nowata OK 74048-2601 |
| Practice Telephone | 9182574244 |
| Practice Fax Number | 9182574247 |
| Mailing Telephone | 9182574244 |
| Mailing Fax Number | 9182574247 |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | REBECCA COX (MIS/REIMBURSEMENT COORDINATOR) |
| Authorized Official Telephone | 9182731841 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251B00000X | Case Management | Agencies |
| Other Name | Type Code |
|---|---|
| Grand Lake Mental Health Center, Inc.-Afton Clinic | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912531344 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 3186 W Highway 412, West Siloam Springs, OK 74338-1356 | 2020-02-25 |
| 1760022602 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 1010 Harbor Rd, Grove, OK 74344-5147 | 2020-01-08 |
| 1932749876 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 211 N Hwy 10 Ste D, Kansas, OK 74347-0000 | 2020-01-08 |
| 1487201133 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 7307 S Yale Ave, Suite 101, Tulsa, OK 74136-7134 | 2019-08-19 |
| 1114458858 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 211 N. Hwy 59 Ste A and B, Kansas, OK 74347-7607 | 2017-03-24 |
| 1598216087 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 1010 Harber Rd, Grove, OK 74344-5147 | 2016-10-19 |
| 1003292061 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 1370 Se Washington Blvd, Bartlesville, OK 74006-4519 | 2015-07-31 |
| 1114269917 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 9432 N. May Ave, Suite D, Oklahoma City, OK 73120-2723 | 2013-03-20 |
| 1104167204 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 9430 N May Ave, Oklahoma City, OK 73120-2712 | 2013-03-14 |
| 1922017060 | Grand Lake Mental Health Center, Inc. | Case Management | 513 S Quapaw Ave, Bartlesville, OK 74003-4331 | 2006-08-07 |
| Street Address |
138 S. MAIN |
| City | AFTON |
| State | OK |
| Zip Code | 74331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710920152 | Debra Maxton Miller | Counselor | 138 S. Main, Afton, OK 74331 | 2006-06-14 |
| 1548760705 | Jamey Andrew Olson | Peer Specialist | 138 S. Main, Afton, OK 74331-1822 | 2018-02-14 |
| 1134635758 | Eddie L Knox Jr. | Case Manager/Care Coordinator | 138 S. Main, Afton, OK 74331-1822 | 2017-12-19 |
| 1518314749 | Jessica Green-wagnon | Registered Nurse | 138 S. Main, Afton, OK 74331-1822 | 2016-05-18 |
| 1740649862 | Angela Britt | Peer Specialist | 138 S. Main, Afton, OK 74331-1822 | 2016-02-17 |
| 1538533690 | Dawn Marie Deknight | Registered Nurse | 138 S. Main, Afton, OK 74331-1822 | 2015-11-30 |
| 1013394634 | Frankie Stewart | Peer Specialist | 138 S. Main, Afton, OK 74331-1822 | 2015-05-04 |
| 1114314168 | Kelli Coble | Counselor | 138 S. Main, Afton, OK 74331-1822 | 2015-04-16 |
| 1326443235 | Angie Hay | Peer Specialist | 138 S. Main, Afton, OK 74331 | 2014-11-04 |
| 1336550797 | Jennifer Osburn | Registered Nurse | 138 S. Main, Afton, OK 74331-1822 | 2014-05-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578114575 | Tena Kennon | Technician | 54301 East 250 Road, Afton, OK 74331 | 2019-09-23 |
| 1376920660 | Dayspring Community Services | Community/Behavioral Health | 3 Southeast 1st St, Afton, OK 74331 | 2015-05-06 |
| 1578742383 | Chiropractic Associates of Miami | Clinic/Center | 30650 S. Lakeside Dr., Afton, OK 74331 | 2007-10-29 |
| 1174735088 | Integrity Emergency Medical Services of Oklahoma LLC | Ambulance | 104 Sw 1st Street, Afton, OK 74331 | 2007-05-04 |
| 1043371198 | Courtland Prentice Smith Jr. | Otolaryngology | 26300 South Hwy 125, Afton, OK 74331 | 2006-12-13 |
| 1639654429 | Sheena Nidiffer | Peer Specialist | 138 S. Main St, Afton, OK 74331 | 2018-09-27 |
| 1003397084 | Jaime Joseph Siegmann | Peer Specialist | 138 S Main St, Afton, OK 74331 | 2018-08-27 |
| 1730674508 | Caleigh Nichols | Social Worker | 138 S Main St, Afton, OK 74331 | 2018-06-25 |
| 1326539768 | Tim R Lucas | Peer Specialist | 138 S Main, Afton, OK 74331 | 2018-05-22 |
| 1043726607 | Rebecca Zinn | Peer Specialist | 138 S Main, Afton, OK 74331 | 2017-12-19 |
| Find all providers in zip 74331 | ||||
| Taxonomy Code | 251B00000X |
| Grouping | Agencies |
| Classification | Case Management |
| An organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services. Case management services may be used to locate, coordinate, and monitor necessary appropriate services. It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services. Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386060424 | Quality Case Management Inc | Case Management | 138 East 7th Ave, Afton, WY 83110-0585 | 2014-03-13 |
| 1235469651 | Path Breakers | Case Management | 320 Preacher Laws Rd, Afton, TN 37616-6450 | 2010-01-07 |
| 1003027889 | Star Valley Senior Center Inc | Case Management | 520 Washington, Afton, WY 83110 | 2007-05-24 |
| 1790201192 | Beyond Home Inc. | Case Management | 153 Doyle Child Circle, Afton, WY 83110 | 2017-08-17 |
| 1295068674 | Lincoln Self Reliance, Inc. | Case Management | 1038 South Washington, Afton, WY 83110 | 2009-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023618758 | Jonathan Nyanquoi Nyanyoun | Case Management | 12508 E 34th St, Tulsa, OK 74146-2218 | 2020-10-30 |
| 1437758323 | Free Your Mind Counseling | Case Management | 10802 Quail Plaza Dr Ste 208, Oklahoma City, OK 73120-3121 | 2020-10-21 |
| 1750997680 | Vanessa Flores | Case Management | 13177 Ne Tony Creek Rd, Elgin, OK 73538-2006 | 2020-09-16 |
| 1619588134 | Coral LLC | Case Management | 12352 Market Dr, Oklahoma City, OK 73114-8136 | 2020-08-10 |
| 1003430497 | Meals On Wheels of Metro Tulsa, Inc. | Case Management | 12620 E 31st St, Tulsa, OK 74146-2307 | 2020-06-02 |
| 1972137107 | Delayna Lynne Marion | Case Management | 109902 S 4570 Rd, Sallisaw, OK 74955-5086 | 2020-02-26 |
| 1649802679 | Amee Renae Brown | Case Management | 9225 E 570 Rd, Kansas, OK 74347-1620 | 2020-02-07 |
| 1780223453 | 20th District Drug Court | Case Management | 39 N Washington St Ste 219, Ardmore, OK 73401-7056 | 2019-12-30 |
| 1528629813 | Medefy Health LLC | Case Management | 8596 E 101st St Ste C, Tulsa, OK 74133-7037 | 2019-06-26 |
| 1033778287 | Sheena M Spies | Case Management | 816 W Oakland St, Broken Arrow, OK 74012-1662 | 2019-06-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.