Grand Lake Mental Health Center, Inc.

NPI #1578103206 in Jay, Oklahoma

Provider Information

NPI Number: 1578103206
Entity Type: Organization
Organization Name: Grand Lake Mental Health Center, Inc.
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Jan 10, 2020
Last Updated: Jun 13, 2022

Practice Location

Address: 1015 W WASHBOURNE ST
City: Jay
State: Oklahoma
ZIP Code: 74346-4205
Phone: (918) 305-5513

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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