GRAND LAKE MENTAL HEALTH CENTER, INC. (NPI# 1467460931) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467460931 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Other Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Practice Address |
114 W Delaware Ave Nowata OK 74048-2601 |
| Practice Telephone | 9182731841 |
| Practice Fax Number | 9182731289 |
| Mailing Telephone | 9182731841 |
| Mailing Fax Number | 9182731289 |
| Enumeration Date | 2006-08-03 |
| 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 | 100732860N | 05 |
| Other Name | Type Code |
|---|---|
| Grand Lake Medical Health Center | Doing Business As Name - Organization |
| Grand Lake Mental Health Center, Inc. | 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 |
114 W DELAWARE AVE |
| City | NOWATA |
| State | OK |
| Zip Code | 74048-2601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134740871 | Christina Wright | Peer Specialist | 114 W Delaware Ave, Nowata, OK 74048-2601 | 2020-05-05 |
| 1972123271 | Ashley Ellen Mcbee | Case Manager/Care Coordinator | 114 W Delaware Ave, Nowata, OK 74048-2601 | 2020-04-16 |
| 1851930473 | Autumn Renee Day | Case Manager/Care Coordinator | 114 W Delaware Ave, Nowata, OK 74048-2601 | 2019-12-30 |
| 1508320656 | Kaitlyn Alexzandria Hall | Case Manager/Care Coordinator | 114 W Delaware Ave, Nowata, OK 74048-2601 | 2019-01-23 |
| 1306322623 | William James Caulfield IIi | Peer Specialist | 114 W Delaware Ave, Nowata, OK 74048-2601 | 2018-07-19 |
| 1174009039 | Robert Jackson | Peer Specialist | 114 W Delaware Ave, Nowata, OK 74048 | 2018-07-13 |
| 1508352030 | Trica Deann Walters | Peer Specialist | 114 W Delaware Ave, Nowata, OK 74048-2601 | 2018-07-09 |
| 1346754405 | Julie Starr Staiger | Case Manager/Care Coordinator | 114 W Delaware Ave, Nowata, OK 74048-2601 | 2017-11-28 |
| 1386178549 | Donna Aultz | Peer Specialist | 114 W Delaware Ave, Nowata, OK 74048-2601 | 2017-04-14 |
| 1962851709 | Tina Nelson | Social Worker | 114 W Delaware Ave, Nowata, OK 74048-2601 | 2016-06-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225647142 | Lacey Catherine Woolman | Case Manager/Care Coordinator | 114 W. Deleware Ave, Nowata, OK 74048 | 2020-07-27 |
| 1891261095 | Kristina E Edens | Counselor | 114 W Deleware, Nowata, OK 74048 | 2018-10-16 |
| 1497247142 | Dustin James Lang | Counselor | 111 W Deleware, Nowata, OK 74048 | 2018-05-30 |
| 1679011928 | Melanie Jane Cline | Counselor | 114 West Delaware, Nowata, OK 74048 | 2017-02-07 |
| 1063955276 | Rebecca A Kidwell | Registered Nurse | 1024 Lenape Drive, Nowata, OK 74048 | 2016-11-21 |
| 1477724912 | City of Nowata Medical Trust Authority | Ambulance | 425 S. Cedar, Nowata, OK 74048 | 2008-03-12 |
| 1023238235 | Charles F Danley | Counselor | 114 W Delaware, Nowata, OK 74048 | 2007-04-27 |
| 1730221177 | Robert Bruce Rickards | Dentist | 117 W Delaware Ave, Nowata, OK 74048 | 2007-02-13 |
| 1023156791 | Debra Keith | Physician Assistant | 237 S Locust, Nowata, OK 74048 | 2007-02-02 |
| 1942390406 | Harold Lowell Meister | Optometrist | 111 North Maple Street, Nowata, OK 74048 | 2006-10-13 |
| Find all providers in zip 74048 | ||||
| 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 |
|---|---|---|---|---|
| 1003456948 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 325 S Ash St, Nowata, OK 74048-4628 | 2020-01-08 |
| 1477851756 | Grand Lake Mental Health Center Inc. | Clinic/Center | 325 S Ash St, Nowata, OK 74048-4628 | 2011-03-10 |
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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.