GRAND LAKE MENTAL HEALTH CENTER INC. NPI 1578103206

NPI Information

NPI: 1578103206
Provider Name: GRAND LAKE MENTAL HEALTH CENTER, INC.

Doing Business As: GRAND MENTAL HEALTH

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
1015 W WASHBOURNE ST
JAY, OK
ZIP 74346
Phone: (918) 305-5513
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GRAND LAKE MENTAL HEALTH CENTER, INC. is a mental health (including community mental health center) clinic center in Jay, OK. GRAND LAKE MENTAL HEALTH CENTER, INC. NPI is 1578103206. The provider is registered as an organization entity type.
The provider Is Doing Business As Grand Mental Health.

The provider's business location address is:

1015 W WASHBOURNE ST
JAY, OK
ZIP 74346-205
Phone: (918) 305-5513
Fax: (918) 253-6645

The provider's authorized official is Larry Smith .
The authorized official title is Ceo and has the following contact phone number (918) 273-1841.

The CLIA number assigned to this NPI record is 37D2176059 - other - ccbhc with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/10/2020 and was last updated on 6/13/2022.

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	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			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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