Grand Lake Mental Health Center, Inc.

NPI #1689165631 in Wagoner, Oklahoma

Provider Information

NPI Number: 1689165631
Entity Type: Organization
Organization Name: Grand Lake Mental Health Center, Inc.
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: May 25, 2018
Last Updated: May 25, 2018

Practice Location

Address: 26243 HIGHWAY 51
City: Wagoner
State: Oklahoma
ZIP Code: 74467-8740
Phone: (918) 708-3006

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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