Grand Lake Mental Health Center, Inc.

NPI #1063817021 in Pryor, Oklahoma

Provider Information

NPI Number: 1063817021
Entity Type: Organization
Organization Name: Grand Lake Mental Health Center, Inc.
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Nov 3, 2014
Last Updated: Jul 31, 2020

Practice Location

Address: 109 N FAIRLAND ST
City: Pryor
State: Oklahoma
ZIP Code: 74361-4203
Phone: (918) 825-1405

Authorized Official

Name: LARRY SMITH
Title: CEO
Phone: (918) 273-1841

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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