Grand Lake Mental Health Center, INC.
Clinic/Center, Mental Health (Including Community Mental Health Center) in Pryor, OK. Organization (NPI-2).
NPI number1336788652
StatusActive
Last updated in NPPESJun 13, 2022
Details
- NPI
- 1336788652
- Entity type
- Organization (NPI-2)
- Legal business name
- Grand Lake Mental Health Center, INC.
- Organization subpart
- No
- Enumeration date
- Jan 3, 2020
- Certification date
- Jun 13, 2022
- Last updated
- Jun 13, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Other names
- Grand Mental Health (Doing Business As)
Practice location
109 N Fairland StPryor, OK 74361-4203
Phone 918-825-1405 · Fax 918-825-1406
Mailing address
114 W Delaware AveNowata, OK 74048-2601
Phone 918-273-1841 · Fax 918-273-1843
Authorized official
Larry Smith
Ceo
9182731841
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All 9 Mental Health Clinic/Center (Including Community Mental Health Center) providers in Pryor · All 606 providers in Pryor
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