GRAND LAKE THERAPEUTICS LLC NPI 1528670239

NPI Information

NPI: 1528670239
Provider Name: GRAND LAKE THERAPEUTICS LLC
Classification: Counselor - 101YP2500X
Entity Type: Organization

Specialization: Professional

Address:
1441 LAKESIDE DR
GROVE, OK
ZIP 74344
Phone: (918) 786-0875
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GRAND LAKE THERAPEUTICS LLC is a professional counselor in Grove, OK. GRAND LAKE THERAPEUTICS LLC NPI is 1528670239. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1441 LAKESIDE DR
GROVE, OK
ZIP 74344-223
Phone: (918) 786-0875

The provider's authorized official is Mitzy Kantor .
The authorized official title is Owner and has the following contact phone number (918) 786-0875.

The enumeration date for this NPI number is 8/24/2020 and was last updated on 8/24/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YP2500X	Counselor	Professional			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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