GRAND MENTAL HEALTH
NPI 1043842370
Clinic/Center - Mental Health (Including Community Mental Health Center) in Ponca City, OK

Q: What is Grand Lake Mental Health Center Inc's NPI number?

The NPI number for Grand Lake Mental Health Center Inc is 1043842370. It was assigned to this organization in the NPPES registry on February 5, 2020. The provider is doing business as Grand Mental Health.

Q: What is Grand Lake Mental Health Center Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Active since February 05, 2020CLIA 37D2173487 · Waiver

407 W SOUTH AVE, PONCA CITY, OK 74601(580) 308-5515(580) 749-5792 Get Directions Write a Review

NPPES record last updated: June 13, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 30, 2021, Feb 5, 2020 (2 updates tracked since 2020).

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About Grand Mental Health NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAND MENTAL HEALTH (NPI 1043842370) is a healthcare organization registered as a mental health (including community mental health center) in Ponca City, Oklahoma and active in the NPI registry since February 2020. The organization holds a CLIA Waiver certificate valid through October 14, 2027 and lists Larry Smith, Ceo, as its authorized official.

NPPES Registry Identity

NPI1043842370

Entity TypeOrganization

Primary Taxonomy261QM0801X

Legal Business NameGRAND LAKE MENTAL HEALTH CENTER INC

Location Address407 W SOUTH AVEPonca City, OK 74601-6133

Mailing Address114 W Delaware AveNowata, OK 74048-2601 · (918) 273-1841 · Fax (918) 273-1843

Phone(580) 308-5515

Fax(580) 749-5792

Organization SubpartNo

Authorized OfficialLarry SmithCeo · (918) 273-1841

Enumeration DateFebruary 5, 2020

Last NPPES UpdateJune 13, 20222 updates tracked since enumeration

NPPES CertifiedJune 13, 2022

✔ NPI 1043842370 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities

Taxonomy Code261QM0801X

407 W SOUTH AVE, Ponca City, OK 74601

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Other Names 1

Doing Business AsGrand Mental Health

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 37D2173487

Grand Mental Health · Ponca City, OK

Active · expires Oct 14, 2027

CLIA Number37D2173487

Laboratory TypeCcbhc

Certificate Effective DateOctober 15, 2025

Certificate Expiration DateOctober 14, 2027

Laboratory DirectorW John Mallgren

Laboratory Phone(918) 418-0994

Laboratory LocationGrand Mental Health407 W S Ave, Ponca City, OK 74601

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEATHER DANIEL

Case Manager/Care Coordinator