| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 325 S Ash St, Nowata, 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 |
|---|---|
114 W Delaware Ave Nowata OK 74048-2601 Ph: (918) 273-1841 | 325 S Ash St Nowata OK 74048-4628 Ph: (918) 273-7344 |
| NPI Number | 1003456948 |
|---|---|
| Provider Enumeration Date | 01/08/2020 |
| Last Update Date | 06/13/2022 |
| Certification Date | 06/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003456948 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Grand Lake Mental Health Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 325 S Ash St, Nowata, OK 74048 Phone: 918-273-7344 Fax: 918-999-0111 |