Grand Lake Mental Health Center, INC.
Clinic/Center, Mental Health (Including Community Mental Health Center) in Stillwater, OK. Organization (NPI-2).
Details
- NPI
- 1972184703
- Entity type
- Organization (NPI-2)
- Legal business name
- Grand Lake Mental Health Center, INC.
- Organization subpart
- No
- Enumeration date
- Apr 14, 2021
- Certification date
- Jun 13, 2022
- Last updated
- Jun 13, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
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
1625 Cimarron PlazaStillwater, OK 74075-3467
Phone 405-372-2202 · Fax 405-445-3780
Mailing address
114 W Delaware AveNowata, OK 74048-2601
Phone 918-273-1841 · Fax 918-273-1843
Authorized official
Larry Smith
Ceo
9182731841
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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