GRAND LAKE MENTAL HEALTH CENTER, INC. (NPI# 1255704250) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1255704250 |
Entity Type | Organization |
Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
Practice Address |
2109 S Highway 69 Wagoner OK 74467-9310 |
Mailing Address |
114 W Delaware Ave Nowata OK 74048-2601 |
Practice Telephone | 9182731841 |
Practice Fax Number | 9182731843 |
Mailing Telephone | 9182731841 |
Mailing Fax Number | 9182731843 |
Enumeration Date | 2015-11-12 |
Last Update Date | 2015-11-12 |
Authorized Official Name | CHARLES DANLEY (CEO) |
Authorized Official Telephone | 9182731841 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
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 |
2109 S HIGHWAY 69 |
City | WAGONER |
State | OK |
Zip Code | 74467-9310 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1629130927 | Deborah Lynn Barnes | Counselor | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2006-12-14 |
1366918914 | Gertrude Grace Haynes | Counselor | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2018-10-22 |
1528562246 | Lori Dyer | Case Manager/Care Coordinator | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2018-03-19 |
1083127070 | Rachel Pentland | Counselor | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2017-11-13 |
1679083166 | Karyn Elizabeth Fox | Peer Specialist | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2017-10-10 |
1215447057 | Lindsey Sarver | Case Manager/Care Coordinator | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2017-10-06 |
1184147209 | Alexandra D'aquin | Case Manager/Care Coordinator | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2017-07-20 |
1669994026 | Charity Michelle Pearce | Case Manager/Care Coordinator | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2017-07-07 |
1194245340 | Elizabeth Lane Mason | Case Manager/Care Coordinator | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2017-06-20 |
1497282065 | Michael E Johnson | Case Manager/Care Coordinator | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2017-05-15 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982251591 | Alesha Lenard | Behavior Technician | 901 S. Harrill Ave, Wagoner, OK 74467 | 2019-08-20 |
1679030597 | Lorri Dawn Pitchford | Case Manager/Care Coordinator | Creoks Behavioral Health Services, 109 S Harrill Ave., Wagoner, OK 74467 | 2019-02-27 |
1144769399 | Elaina Murray | Technician | 308 Ne 2nd St., Wagoner, OK 74467 | 2017-02-21 |
1336699784 | Tommye Evidson | Counselor | 109 Harrill Ave, Wagoner, OK 74467 | 2016-10-10 |
1518327857 | Yco Tulsa, Inc | Clinic/Center | 1101a South Mcquarrie, Wagoner, OK 74467 | 2016-02-29 |
1396117545 | Sandra Cooper | Behavioral Analyst | 2109 Us-69, Wagoner, OK 74467 | 2015-10-28 |
1588051486 | Penny Nye | Counselor | 2109 S.hwy 69, Wagoner, OK 74467 | 2015-04-20 |
1376943571 | Justin F Kurtz | Respiratory Therapist, Certified | 1200 W. Cherokee, Suite H Cardiac/pulmonary Rehab, Wagoner, OK 74467 | 2014-08-26 |
1780009969 | David H Good | Family Medicine | 1202 W. Cherokee St, Ste E, Wagoner, OK 74467 | 2014-02-25 |
1942598875 | Robin Rodriguez-higginbottom | Speech-Language Pathologist | 215 E Cherokee St, Wagoner, OK 74467 | 2011-07-12 |
Find all providers in zip 74467 |
Taxonomy Code | 261QM0801X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Mental Health (Including Community Mental Health Center) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518327857 | Yco Tulsa, Inc | Clinic/Center | 1101a South Mcquarrie, Wagoner, OK 74467 | 2016-02-29 |
1265049654 | Shayla Ricchele Phillips | Clinic/Center | 109 S Harrill Ave, Wagoner, OK 74467-5317 | 2020-09-29 |
1689165631 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 26243 Highway 51, Wagoner, OK 74467-8740 | 2018-05-25 |
1932523867 | James Foreman | Clinic/Center | 118 S Main St, Wagoner, OK 74467-5221 | 2014-02-12 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649870742 | Sequelcare of Oklahoma, LLC | Clinic/Center | 6218 S Lewis Ave Ste 118, Tulsa, OK 74136-1018 | 2020-10-28 |
1649870890 | M & M Counseling Group, LLC | Clinic/Center | 207 S Czech Hall Rd, Yukon, OK 73099-6851 | 2020-10-27 |
1992303721 | Misty Watkins | Clinic/Center | 1601 Sw Parkridge Blvd Ste 200, Lawton, OK 73505-7564 | 2020-10-14 |
1295342046 | Integrative Healthcare Solutions LLC | Clinic/Center | 2227 E 8th St, Tulsa, OK 74104-3237 | 2020-09-25 |
1235744020 | Strength of A Warrior Counseling Services LLC | Clinic/Center | 4516 Se 25th St, Del City, OK 73115-4114 | 2020-09-09 |
1609488253 | Alexie Foster, LLC | Clinic/Center | 16802 S 301st West Ave, Bristow, OK 74010-2265 | 2020-08-17 |
1306455068 | Restore Family Counseling, LLC | Clinic/Center | 100 W. Wilshire, Suite #c3, Oklahoma City, OK 73116 | 2020-07-29 |
1245855857 | Dragonfly Psychotherapy | Clinic/Center | 2942 Ne Orlie Dr, Forest Park, OK 73121-2436 | 2020-06-09 |
1508480872 | Maria Nancy Martinez | Clinic/Center | 5350 S Western Ave Ste 217, Oklahoma City, OK 73109-4525 | 2020-06-03 |
1649894015 | Miranda Rackers | Clinic/Center | 1308 E Mckinley Ave, Sapulpa, OK 74066-4824 | 2020-06-02 |
Find all providers with the same taxonomy |
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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.