| Courtney Shiann Anderson, BHP | |
| 109 N Fairland St, Pryor, OK 74361-4203 | |
| (918) 825-1405 | |
| (918) 825-1406 | 
| Full Name | Courtney Shiann Anderson | 
|---|---|
| Gender | Female | 
| Speciality | Counselor - Mental Health | 
| Location | 109 N Fairland St, Pryor, Oklahoma | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1114435955 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary | 
| Entity Name | Grand Lake Mental Health Center, Inc. | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1497762520 PECOS PAC ID: 4688711534 Enrollment ID: O20091026000174 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Courtney Shiann Anderson, BHP 109 N Fairland St, Pryor, OK 74361-4203 Ph: (918) 825-1405 | Courtney Shiann Anderson, BHP 109 N Fairland St, Pryor, OK 74361-4203 Ph: (918) 825-1405 | 
| Breanna Nicole Cook, MHR, LPC-C Counselor Medicare: Not Enrolled in Medicare Practice Location: 109 N Fairland St, Pryor, OK 74361 Phone: 918-825-1401 Fax: 918-825-1406 | |
| Jacqueline Marie Flynn,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 231 E Graham Ave, Pryor, OK 74361 Phone: 918-825-1405 | |
| Ladena Carol Moore, LPC NCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 212 S E 1st, Pryor, OK 74361 Phone: 918-825-4115 Fax: 918-825-6612 | |
| Mrs. Kara Jamison, LPC Counselor Medicare: Medicare Enrolled Practice Location: 109 N Fairland St, Pryor, OK 74361 Phone: 918-825-1405 | |
| Charity Dalaina Hall, LPC Counselor Medicare: Medicare Enrolled Practice Location: 231 E Graham Ave, Pryor, OK 74361 Phone: 918-520-0722 | |
| Janette Marie Nuspl, LPC, NCC Counselor Medicare: Medicare Enrolled Practice Location: 231 E Graham Ave, Pryor, OK 74361 Phone: 918-825-1405 |