GRAND LAKE MENTAL HEALTH CENTER, INC. (NPI# 1316954431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316954431 |
| 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 74331-1822 |
| Mailing Address |
114 W Delaware Ave Nowata OK 74048-2601 |
| Practice Telephone | 9182572444 |
| Practice Fax Number | 9182574247 |
| Mailing Telephone | 9182574244 |
| Mailing Fax Number | 9182574247 |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-07-31 |
| Authorized Official Name | LARRY SMITH (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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100728510A | 05 |
| Other Name | Type Code |
|---|---|
| Grand Lake Medical Health Center | Doing Business As Name - Organization |
| 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 | 74331-1822 |
| 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 | 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 |
|---|---|---|---|---|
| 1366082208 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 138 S Main St, Afton, OK 74331-1822 | 2020-01-08 |
| 1841600863 | Grand Lake Mental Health Center Inc. | Clinic/Center | 138 S Main, Afton, OK 74331-1822 | 2014-04-29 |
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|---|---|---|---|---|
| 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.