| Grand Lake Mental Health Center, Inc. | |
|
1228 Pecan Pawhuska OK 74056-5928 | |
| (918) 604-6054 | |
| (918) 777-9018 |
| Full Name | Grand Lake Mental Health Center, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1228 Pecan, Pawhuska, Oklahoma |
| Authorized Official Name and Position | Larry Smith (CEO) |
| Authorized Official Contact | 9182731841 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Lake Mental Health Center, Inc. 114 W Delaware Ave Nowata OK 74048-2601 Ph: (918) 273-1841 | Grand Lake Mental Health Center, Inc. 1228 Pecan Pawhuska OK 74056-5928 Ph: (918) 604-6054 |
| NPI Number | 1598305211 |
|---|---|
| Provider Enumeration Date | 01/10/2020 |
| Last Update Date | 10/31/2022 |
| Certification Date | 10/31/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598305211 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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Grand Lake Mental Health Center Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1228 Pecan, Pawhuska, OK 74056 Phone: 918-604-6054 Fax: 918-777-9018 | |
Grand Lake Mental Health Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 124 E 6th St, Pawhuska, OK 74056 Phone: 918-604-6054 Fax: 918-777-9018 |