GRAND LAKE MENTAL HEALTH CENTER INC (NPI# 1659904076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659904076 |
| Entity Type | Organization |
| Organization Name | GRAND LAKE MENTAL HEALTH CENTER INC |
| Practice Address |
4815 S Harvard Ave Ste 420 Tulsa OK 74135-3068 |
| Practice Telephone | 9182731841 |
| Practice Fax Number | 9182731843 |
| Mailing Telephone | 9182731841 |
| Mailing Fax Number | 9182731843 |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2020-02-13 |
| 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, Inc. | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356981138 | Grand Lake Mental Health Center Inc | Community/Behavioral Health | 2225 N Union, Ponca City, OK 74601-1536 | 2020-01-09 |
| 1588136758 | Grand Lake Mental Health Center Inc | Clinic/Center | 4815 S. Harvard, Suite 420, Tulsa, OK 74135-3068 | 2018-12-27 |
| 1295145217 | Grand Lake Mental Health Center Inc | Clinic/Center | 1115 S Harber Rd, Grove, OK 74344-7918 | 2014-04-29 |
| 1043842370 | Grand Lake Mental Health Center Inc | Clinic/Center | 2225 N Union St., Ponca City, OK 74601-7460 | 2020-02-05 |
| 1689206922 | Grand Lake Mental Health Center Inc | Clinic/Center | 1015 W Washbourne St, Jay, OK 74346-4205 | 2020-02-05 |
| 1992341671 | Grand Lake Mental Health Center Inc | Clinic/Center | 1624 Cimarron Plz, Stillwater, OK 74075-3467 | 2019-11-18 |
| 1457993834 | Grand Lake Mental Health Center Inc | Clinic/Center | 124 E 6th St, Pawhuska, OK 74056-4204 | 2019-10-17 |
| 1134539141 | Grand Lake Mental Health Center Inc | Clinic/Center | 12005 E 470 Rd, Claremore, OK 74017-3737 | 2014-04-29 |
| 1588074595 | Grand Lake Mental Health Center Inc | Clinic/Center | 111 S Treaty Rd, Miami, OK 74354-5327 | 2014-04-29 |
| Street Address |
4815 S HARVARD AVE STE 420 |
| City | TULSA |
| State | OK |
| Zip Code | 74135-3068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761590 | Dr. Whitney M. Ellsworth, Dpt, Pllc | Physical Therapist | 4185 S Harvard Ave, Suite E-1, Tulsa, OK 74135 | 2020-08-20 |
| 1942839089 | Kimberly Renee Gillens | Student in an Organized Health Care Education/Training Program | 4502 E 41st Street Obgyn Department, Tulsa, OK 74135 | 2020-04-01 |
| 1528525524 | Everest Pain Management | Clinic/Center | 4134 S Harvard Ave Suite B1, Tulsa, OK 74135 | 2019-02-26 |
| 1326524216 | Shelley Deeann Anderson | Technician | 7359 S 68th, Tulsa, OK 74135 | 2018-07-14 |
| 1811489065 | Taylor Diane Spears | Behavioral Analyst | 4835 S Fulton Ave Suite 104, Tulsa, OK 74135 | 2018-06-04 |
| 1225547821 | Heather Nicole Freed | Counselor | 4363 S Harvard Ave, Tulsa, OK 74135 | 2017-09-26 |
| 1306363924 | Danielle Walker | Case Manager/Care Coordinator | 3244 S Lakewood Ave Apt 4e, Tulsa, OK 74135 | 2017-08-24 |
| 1346766078 | Angels Place | Day Training, Developmentally Disabled Services | 3919 S. Oswego Avenue, Tulsa, OK 74135 | 2017-08-15 |
| 1659800019 | Welena-phay Kamamma Boren | Counselor | 4636 S Harvard Avenue, Tulsa, OK 74135 | 2017-06-08 |
| 1346774197 | Brandie Herren | Registered Nurse | 6333 E Skelly Drive, Tulsa, OK 74135 | 2017-04-19 |
| Find all providers in zip 74135 | ||||
| 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 |
|---|---|---|---|---|
| 1649870742 | Sequelcare of Oklahoma, LLC | Clinic/Center | 6218 S Lewis Ave Ste 118, Tulsa, OK 74136-1018 | 2020-10-28 |
| 1295342046 | Integrative Healthcare Solutions LLC | Clinic/Center | 2227 E 8th St, Tulsa, OK 74104-3237 | 2020-09-25 |
| 1487201133 | Grand Lake Mental Health Center, Inc. | Clinic/Center | 7307 S Yale Ave, Suite 101, Tulsa, OK 74136-7134 | 2019-08-19 |
| 1235694803 | Genes Progeny | Clinic/Center | 9243 S 91st East Ave, Tulsa, OK 74133-5645 | 2019-02-07 |
| 1588136758 | Grand Lake Mental Health Center Inc | Clinic/Center | 4815 S. Harvard, Suite 420, Tulsa, OK 74135-3068 | 2018-12-27 |
| 1730606153 | Consolation Counseling Services, LLC | Clinic/Center | 2326 S Garnett Rd Ste K, Tulsa, OK 74129-5118 | 2017-08-25 |
| 1326569252 | Gilead Counseling Center LLC | Clinic/Center | 2448 E 81st St Ste 2045, Tulsa, OK 74137-4271 | 2017-06-30 |
| 1578580916 | State of Oklahoma | Clinic/Center | 2323 S Harvard Ave, Tulsa, OK 74114-3301 | 2006-07-15 |
| 1013527944 | Shanna Eischen Consulting and Counseling LLC | Clinic/Center | 6308 E 15th St Ste 2c, Tulsa, OK 74112-6411 | 2020-08-05 |
| 1669082699 | Rick A Phipps | Clinic/Center | 4103 S Yale Ave, Tulsa, OK 74135-6002 | 2020-08-04 |
| Find all providers in TULSA | ||||
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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.