GRAND LAKE MENTAL HEALTH CENTER, INC. (NPI# 1710994835) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710994835 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Other Organization Name | GRAND LAKE MEDICAL CENTER |
| Practice Address |
405 E Excelsior Ave Vinita OK 74301-4226 |
| Mailing Address |
114 W Delaware Ave Nowata OK 74048-2601 |
| Practice Telephone | 9182566476 |
| Practice Fax Number | 9182563628 |
| Mailing Telephone | 9182566476 |
| Mailing Fax Number | 9182563628 |
| 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 | 100732860F | 05 |
| Other Name | Type Code |
|---|---|
| Grand Lake Medical Center | Doing Business As Name - Organization |
| Grand Lake Mental Health Center, Inc.-Craig County | 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 |
405 E EXCELSIOR AVE |
| City | VINITA |
| State | OK |
| Zip Code | 74301-4226 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023625563 | Steven Ray Coatney | Peer Specialist | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-09-29 |
| 1932712775 | Karen Tiscareno | Peer Specialist | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-08-30 |
| 1669085528 | Felicia Johnson | Peer Specialist | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-08-28 |
| 1508474982 | Kari West | Case Manager/Care Coordinator | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-07-21 |
| 1770108920 | India Leigh Uhlemeyer | Peer Specialist | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-06-13 |
| 1356964399 | Allison L Andrasko | Registered Nurse | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-05-26 |
| 1861013070 | Chad H Wiens | Registered Nurse | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-04-28 |
| 1154940005 | Lisa R Farbro | Case Manager/Care Coordinator | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-04-10 |
| 1215569413 | Laytin Allen Parker | Peer Specialist | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-02-06 |
| 1447890488 | Mariah Lynn Armstrong | Peer Specialist | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-01-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740786 | Jennifer Lynn Black | Registered Nurse | 24919 S 4420 Road, Vinita, OK 74301 | 2020-11-03 |
| 1720686272 | Chancie Marie Cooper | Case Manager/Care Coordinator | 444 737 Hwy 28, Vinita, OK 74301 | 2020-10-15 |
| 1265082515 | Ruth Irving | Technician | 843 North Miller, Vinita, OK 74301 | 2019-09-18 |
| 1952897449 | Sarah Renee Gilmore | Behavior Technician | 526 N. Brewer, Vinita, OK 74301 | 2018-07-08 |
| 1134664683 | Sheila Mason | Nurse Practitioner | Department of Veterans Affairs Clinic, 269 South 7th Street, Vinita, OK 74301 | 2016-12-19 |
| 1881145274 | Saint Francis Hospital Vinita, Inc | Clinic/Center | 711 North Brewer Street, Vinita, OK 74301 | 2016-10-20 |
| 1699147249 | Beth Powell | Peer Specialist | 405 East Excelsior Ave, Vinita, OK 74301 | 2015-10-22 |
| 1790196202 | Peter Rausch | Psychologist | 735 N. Foreman St., Vinita, OK 74301 | 2014-05-19 |
| 1548605041 | Anita Joy Cantrell | Counselor | 1520 North Industrial Ave, Vinita, OK 74301 | 2013-05-10 |
| 1033469606 | Matt Lance Oldacre | Pharmacist | 525 S. Wilson, Vinita, OK 74301 | 2012-09-11 |
| Find all providers in zip 74301 | ||||
| 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 |
|---|---|---|---|---|
| 1114351541 | Santa Fe Residential Care Home | Clinic/Center | 618 E Canadian Ave, Vinita, OK 74301-3810 | 2013-08-21 |
| 1407061088 | Rose Rock Recovery Center | Clinic/Center | 442104 E. 250 Rd., Vinita, OK 74301 | 2007-05-14 |
| 1518506831 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2020-01-03 |
| 1679983696 | Grand Lake Mental Health Center Inc. | Clinic/Center | 405 E Excelsior Ave, Vinita, OK 74301-4226 | 2014-04-29 |
| 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.