Grand Lake Mental Health Center, Inc.

NPI #1255704250 in Wagoner, Oklahoma

Provider Information

NPI Number: 1255704250
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 12, 2015
Last Updated: Nov 12, 2015

Practice Location

Address: 2109 S HIGHWAY 69
City: Wagoner
State: Oklahoma
ZIP Code: 74467-9310
Phone: (918) 273-1841

Authorized Official

Name: CHARLES DANLEY
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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