Grand Lake Mental Health

NPI #1275171274 in Miami, Oklahoma

Provider Information

NPI Number: 1275171274
Entity Type: Organization
Organization Name: Grand Lake Mental Health
Primary Specialty: Peer Specialist
Enumeration Date: Dec 20, 2019
Last Updated: Jan 23, 2020

Practice Location

Address: 111 S TREATY RD
City: Miami
State: Oklahoma
ZIP Code: 74354-5327
Phone: (918) 418-3062

Authorized Official

Name: ALEXIS AUSTIN
Title: RSS
Phone: (918) 791-5453

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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