GRAND LAKE MENTAL HEALTH CENTER, INC. (NPI# 1336788652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336788652 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Practice Address |
109 N Fairland St Pryor OK 74361-4203 |
| Mailing Address |
114 W Delaware Ave Nowata OK 74048-2601 |
| Practice Telephone | 9188251405 |
| Practice Fax Number | 9188251406 |
| Mailing Telephone | 9182731841 |
| Mailing Fax Number | 9182731843 |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2020-01-03 |
| 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 |
| 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 |
109 N FAIRLAND ST |
| City | PRYOR |
| State | OK |
| Zip Code | 74361-4203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942286133 | Jan Ellen Wells | Nurse Practitioner | 109 N Fairland St, Suite 104, Pryor, OK 74361-4203 | 2005-12-19 |
| 1740893296 | Erin Dinsmore | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-08-25 |
| 1609489228 | Wendy Dotson | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-08-24 |
| 1063022077 | Daylon Cheyenne Ramsey | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-08-04 |
| 1548885502 | Riley Danielle Pope | Counselor | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-06-15 |
| 1013532076 | Breanna Nicole Cook | Counselor | 109 N Fairland St, Pryor, OK 74361-4205 | 2020-06-15 |
| 1285254490 | Briana Renee Andrews | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-04-17 |
| 1215556410 | Carly Ann Disalvatore | Case Manager/Care Coordinator | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-04-09 |
| 1568081677 | Zack Ellard | Peer Specialist | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-04-09 |
| 1518593011 | Klarissa Autumn Hall | Occupational Therapy Assistant | 109 N Fairland St, Pryor, OK 74361-4203 | 2020-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787928 | Ahs Pryor Hospital, LLC | Clinic/Center | 1301 Ne 1st St Ste 400, Pryor, OK 74361 | 2018-04-12 |
| 1073029310 | Amber Bowman | Registered Nurse | 109 N. Fairland, Pryor, OK 74361 | 2017-12-22 |
| 1922361096 | Crystal Noel Parrett | Counselor | 215 N. Fairland, Pryor, OK 74361 | 2012-06-22 |
| 1447516703 | Rocky Mountain Holdings LLC | Ambulance | 591 Airport Rd, Pryor, OK 74361 | 2012-04-11 |
| 1356673180 | Tressa Fern Rice | Speech-Language Pathologist | 510 S. Elliott St. Suite C, Mayes County Speech Therapy, Pryor, OK 74361 | 2010-02-04 |
| 1083945208 | Ladena Carol Moore | Counselor | 212 S E 1st, Pryor, OK 74361 | 2010-01-28 |
| 1164753323 | Anita K Sanders | Counselor | 212 Se 1st, Pryor, OK 74361 | 2010-01-27 |
| 1619203775 | Sandra Kay Runnells | Psychologist | 109 South Fairland, Suite 101, Pryor, OK 74361 | 2009-10-26 |
| 1972838969 | Ramona L Whitehurst | Advanced Practice Midwife | 1400 Willow Road, Pryor, OK 74361 | 2009-10-08 |
| 1396971297 | Shauna Leann Jackson | Speech-Language Pathologist | 510 S. Elliott, Suite C, Pryor, OK 74361 | 2009-06-05 |
| Find all providers in zip 74361 | ||||
| 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 |
|---|---|---|---|---|
| 1245699339 | Yco Tulsa, Inc | Clinic/Center | 447 S Wood St, Pryor, OK 74361-6043 | 2016-02-17 |
| 1407912371 | People Inc. of Sequoyah Co | Clinic/Center | 32 S Adair St, Pryor, OK 74361-3614 | 2006-12-28 |
| 1902394976 | Penny Lynn Stone | Clinic/Center | 109 N Fairland St, Pryor, OK 74361-4203 | 2018-04-25 |
| 1063817021 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 109 N Fairland St, Pryor, OK 74361-4203 | 2014-11-03 |
| 1871500900 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 109 N Fairland St, Pryor, OK 74361-4203 | 2006-08-02 |
| 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.