GRAND LAKE MENTAL HEALTH CENTER, INC. (NPI# 1689165631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1689165631 |
Entity Type | Organization |
Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
Practice Address |
26243 Highway 51 Wagoner OK 74467-8740 |
Mailing Address |
114 W Delaware Ave Nowata OK 74048-2601 |
Practice Telephone | 9187083006 |
Practice Fax Number | 9189990109 |
Mailing Telephone | 9182731841 |
Mailing Fax Number | 9182731843 |
Enumeration Date | 2018-05-25 |
Last Update Date | 2018-05-25 |
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 |
26243 HIGHWAY 51 |
City | WAGONER |
State | OK |
Zip Code | 74467-8740 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750547816 | Shawna Danette Martin | Case Manager/Care Coordinator | 26243 Highway 51, Wagoner, OK 74467-8740 | 2008-07-29 |
1871052423 | Laura Darlene Patterson | Case Manager/Care Coordinator | 26243 Highway 51, Wagoner, OK 74467-8740 | 2019-03-13 |
1164930822 | Andrea Hamlet | Case Manager/Care Coordinator | 26243 Highway 51, Wagoner, OK 74467 | 2018-01-16 |
1699204792 | Cortez De'angelo Edwards | Case Manager/Care Coordinator | 26243 Highway 51, Wagoner, OK 74467-8740 | 2017-06-12 |
1487180022 | Zach Pierce | Case Manager/Care Coordinator | 26243 Highway 51, Wagoner, OK 74467-8740 | 2017-05-02 |
1417323254 | Haley Dixon | Counselor | 26243 Highway 51, Wagoner, OK 74467-8740 | 2015-08-17 |
1568838597 | Misty Foutch | Counselor | 26243 Highway 51, Wagoner, OK 74467-8740 | 2015-08-13 |
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 |
1255704250 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 2109 S Highway 69, Wagoner, OK 74467-9310 | 2015-11-12 |
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.