GRAND LAKE MENTAL HEALTH CENTER, INC. (NPI# 1306394788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306394788 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Other Organization Name | GRAND LAKE MEDICAL HEALTH CENTER |
| Practice Address |
110 N 4th St Ponca City OK 74601-4527 |
| Mailing Address |
114 W Delaware Ave Nowata OK 74048-2601 |
| Practice Telephone | 9182731841 |
| Practice Fax Number | 9182731843 |
| Mailing Telephone | 9182731841 |
| Mailing Fax Number | 9182731843 |
| Enumeration Date | 2016-09-14 |
| 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 |
| Other Name | Type Code |
|---|---|
| Grand Lake Medical Health Center | Doing Business As Name - 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 |
110 N 4TH ST |
| City | PONCA CITY |
| State | OK |
| Zip Code | 74601-4527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316969157 | Lisa Ann Seabridge | Social Worker | 110 N 4th St, Ponca City, OK 74601 | 2006-07-24 |
| 1558989897 | Esther Adedayo | Counselor | 110 N 4th St, Ponca City, OK 74601-4527 | 2020-07-13 |
| 1083233050 | Daniel James Shaffer | Case Manager/Care Coordinator | 110 N 4th St, Ponca City, OK 74601-4527 | 2020-04-10 |
| 1366079774 | Tonya Marie Hill | Case Manager/Care Coordinator | 110 N 4th St, Ponca City, OK 74601-4527 | 2020-03-25 |
| 1831725654 | Jacqueline Anders Benatar | Case Manager/Care Coordinator | 110 N 4th St, Ponca City, OK 74601-4527 | 2020-03-13 |
| 1952941486 | Diana Llaquelly Chaires | Case Manager/Care Coordinator | 110 N 4th St, Ponca City, OK 74601-4527 | 2020-01-13 |
| 1174163810 | Carol M. Jensen-fry | Case Manager/Care Coordinator | 110 N 4th St, Ponca City, OK 74601-4527 | 2020-01-10 |
| 1851931794 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 110 N 4th St, Ponca City, OK 74601-4527 | 2020-01-08 |
| 1710526587 | Ashley Lee Adams | Case Manager/Care Coordinator | 110 N 4th St, Ponca City, OK 74601-4527 | 2019-12-27 |
| 1346889169 | Joy Diane Butler | Registered Nurse | 110 N 4th St, Ponca City, OK 74601-4527 | 2019-12-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245867258 | Triad Health Systems LLC | Family Medicine | 2703 N 14th St, Ponca City, OK 74601 | 2020-03-27 |
| 1679096952 | Gabrielle Evangeline Barnes | Case Manager/Care Coordinator | 620 W. Grand, Ponca City, OK 74601 | 2017-07-19 |
| 1942722889 | Kimbra Leigh Anderson | Case Manager/Care Coordinator | 1500 N. 6th, Ponca City, OK 74601 | 2017-07-12 |
| 1033631965 | Kayla Patten | Case Manager/Care Coordinator | 620 W Grand, Ponca, OK 74601 | 2017-07-12 |
| 1639601859 | Affordable Dental | Dentist | 1618 N 5th St Ste 4, Ponca City, OK 74601 | 2017-03-28 |
| 1447627237 | Harold Jason Laughlin Jr. | Chiropractor | 222 E. Grand, Ste. 309, Ponca City, OK 74601 | 2015-08-27 |
| 1578947875 | Jessica James | Social Worker | 1500 N 6th, Ponca City, OK 74601 | 2015-07-16 |
| 1639565153 | Ryian Reyes | Point of Service | 2101 N 14th, Suite 134, Ponca City, OK 74601 | 2015-04-10 |
| 1003253006 | Proving Faithful Investments Inc. | Home Health | 205 W. Hartford Avenue #112, Ponca City, OK 74601 | 2013-05-30 |
| 1427365899 | Quint Allen Whitefield | Dentist | 1618 N. 5th Street, Suite #2, Ponca City, OK 74601 | 2010-09-08 |
| Find all providers in zip 74601 | ||||
| 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 |
|---|---|---|---|---|
| 1609224484 | Warren Rivers | Clinic/Center | 602 W. Grand Avenue, Bridgeway Inc, Ponca City, OK 74602-0883 | 2016-06-02 |
| 1851415673 | Cimarron Valley Therapeutic Services, Inc. | Clinic/Center | 205 W Hartford Ave, Ponca City, OK 74601-1547 | 2007-03-19 |
| 1043842370 | Grand Lake Mental Health Center Inc | Clinic/Center | 2225 N Union St., Ponca City, OK 74601-7460 | 2020-02-05 |
| 1851931794 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 110 N 4th St, Ponca City, OK 74601-4527 | 2020-01-08 |
| 1447812029 | Creoks Behavioral Health Services | Clinic/Center | 1500 N 6th St, Ponca City, OK 74601-2827 | 2019-07-03 |
| 1821403643 | Healing Heart and Mind Counseling, LLC | Clinic/Center | 222 E Grand Ave, Suite 300, Ponca City, OK 74601-4316 | 2014-07-01 |
| 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 | ||||
| City | PONCA CITY |
| Zip Code | 74601 |
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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.