GRAND LAKE MENTAL HEALTH CENTER, INC. (NPI# 1407228752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1407228752 |
Entity Type | Organization |
Organization Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
Practice Address |
1323 W Keetoowah St Tahlequah OK 74464-3462 |
Mailing Address |
114 W Delaware Ave Nowata OK 74048-2601 |
Practice Telephone | 9187083006 |
Practice Fax Number | 9187779016 |
Mailing Telephone | 9182731841 |
Mailing Fax Number | 9182731843 |
Enumeration Date | 2015-10-27 |
Last Update Date | 2018-01-16 |
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 |
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 |
1323 W KEETOOWAH ST |
City | TAHLEQUAH |
State | OK |
Zip Code | 74464-3462 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1295920734 | Loftin Family Practice | Clinic/Center | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2007-09-07 |
1326516022 | Rachel Elizabeth Clinton | Case Manager/Care Coordinator | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2018-11-12 |
1720560261 | Michelle Renee Shade | Case Manager/Care Coordinator | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2018-08-31 |
1548759327 | Holly Caddell | Counselor | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2018-05-07 |
1952804106 | Kristina Stricker | Case Manager/Care Coordinator | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2018-03-14 |
1326558008 | Stephanie Jolene Whipple | Case Manager/Care Coordinator | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2017-10-06 |
1740623537 | Jennifer A Baker | Marriage & Family Therapist | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2013-04-10 |
1629302674 | Brett Hiseley | Counselor | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2009-09-23 |
1881835544 | Kevin W. Perry | Counselor | 1323 W Keetoowah St, Tahlequah, OK 74464-3462 | 2009-03-10 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184253403 | Kendall Harris | Student in an Organized Health Care Education/Training Program | 100 Bliss Ave, Tahlequah, OK 74464 | 2020-04-07 |
1528609302 | Norma Brightly | Technician | 103 Sequoyah, Tahlequah, OK 74464 | 2019-10-03 |
1073175832 | Jody Lynn Dallis | Case Manager/Care Coordinator | Tenkiller Behavioral Services, 27753 S. Welling Rd, Welling, OK 74464 | 2019-07-02 |
1184287849 | Perry Jake Proctor | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, Ok 74464, Tahlequah, OK 74464 | 2019-04-18 |
1336657279 | Sidney Sheyenne Kimble | Case Manager/Care Coordinator | 1429 Jack Brown Lane, Tahlequah, OK 74464 | 2018-01-12 |
1891225686 | Nichols Bradley Alberty | Orthotist | 1294 East Downing, Suite 3, Tahlequah, OK 74464 | 2017-06-14 |
1922549690 | Krystal Easter Ms, Lpc | Counselor | 2201 Oakridge Dr, Tahlequah, OK 74464 | 2017-03-15 |
1144777319 | Northeastern Oklahoma Community Health Centers, Inc. | Clinic/Center | 529 N. Oak St., Tahlequah, OK 74464 | 2016-09-06 |
1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
1033532635 | Wesley Gragg | Specialist/Technologist | 603 North Grand Avenue, Tahlequah, OK 74464 | 2014-02-03 |
Find all providers in zip 74464 |
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 |
---|---|---|---|---|
1508987959 | State of Oklahoma; Dba:bill Willis Community Mental Health Center | Clinic/Center | 1400 S. Hensley Dr, Tahlequah, OK 74465-0558 | 2007-04-03 |
1235295130 | People Inc. of Sequoyah Co | Clinic/Center | 1606 E Downing St, Tahlequah, OK 74464-2513 | 2006-12-28 |
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.