1. Home
  2. Directory
  3. Oklahoma
  4. Jay
  5. Clinic Center
  6. NPI Profile

GRAND MENTAL HEALTH
NPI 1255979415
Clinic/Center - Mental Health (Including Community Mental Health Center) in Jay, OK

Active since December 18, 2019CLIA 37D2176059 · Waiver
1015 W WASHBOURNE ST, JAY, OK 74346(918) 308-5513(918) 253-6645 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: Jul 31, 2020, Dec 18, 2019 (2 updates tracked since 2019).

About Grand Mental Health NPPES

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

GRAND MENTAL HEALTH (NPI 1255979415) is a healthcare organization registered as a mental health (including community mental health center) in Jay, Oklahoma and active in the NPI registry since December 2019. The organization holds a CLIA Waiver certificate valid through December 5, 2027 and lists Larry Smith, Ceo, as its authorized official.

NPPES Registry Identity

NPI1255979415
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameGRAND LAKE MENTAL HEALTH CENTER, INC.
Location Address1015 W WASHBOURNE STJay, OK 74346-4205
Mailing Address114 W Delaware AveNowata, OK 74048-2601 · (918) 273-1841 · Fax (918) 273-1843
Phone(918) 308-5513
Fax(918) 253-6645
Organization SubpartNo
Authorized OfficialLarry SmithCeo · (918) 273-1841
Enumeration DateDecember 18, 2019
Last NPPES UpdateJune 13, 20222 updates tracked since enumeration
NPPES CertifiedJune 13, 2022
✔ NPI 1255979415 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
1015 W WASHBOURNE ST, Jay, OK 74346
Open in Google Maps ↗

Other Names 1

Doing Business AsGrand Mental Health

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Oklahoma.Insurance ›

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 37D2176059

Grand Mental Health · Jay, OK
Active · expires Dec 5, 2027
CLIA Number37D2176059
Laboratory TypeCcbhc
Certificate Effective DateDecember 6, 2025
Certificate Expiration DateDecember 5, 2027
Laboratory DirectorW John Mallgren
Laboratory Phone(918) 418-0994
Laboratory LocationGrand Mental Health1015 W Washbourne, Jay, OK 74346
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.

TRAVIS VIRON KERSH
Peer Specialist
1015 W WASHBOURNE ST
JAY, OK 74346
Delaware County (844) 458-2100
JADE ALEXANDRIA FRAZIER RN
Case Manager/Care Coordinator
1015 W WASHBOURNE ST
JAY, OK 74346
Delaware County (844) 458-2100
ALISHA DAWN HUGHES
Behavior Analyst
1015 W WASHBOURNE ST
JAY, OK 74346
Delaware County (918) 308-5513
ANDREW C WICKLINE
Case Manager/Care Coordinator
1015 W WASHBOURNE ST
JAY, OK 74346
Delaware County (918) 868-7489
ELIZABETH BUCHANAN
Counselor (Mental Health)
1015 W WASHBOURNE ST
JAY, OK 74346
Delaware County (918) 308-5513
MRS. KRISTEN LEANN BOLDRA
Peer Specialist
1015 W WASHBOURNE ST
JAY, OK 74346
Delaware County (918) 308-5513
KARLIE ROSE BUSH LPN
Licensed Practical Nurse
1015 W WASHBOURNE ST
JAY, OK 74346
Delaware County (844) 458-2100
DR. STEFAN SHANE HACKER DDS
Dentist
1015 W WASHBOURNE ST
JAY, OK 74346
Delaware County (918) 253-8696

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grand Lake Mental Health Center, Inc.'s NPI number?

The NPI number for Grand Lake Mental Health Center, Inc. is 1255979415. It was assigned to this organization in the NPPES registry on December 18, 2019. The provider is doing business as Grand Mental Health.

Where is Grand Lake Mental Health Center, Inc. located?

Grand Lake Mental Health Center, Inc. is located at 1015 W Washbourne St, Jay, OK 74346. The listed phone number is (918) 308-5513.

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.

Does Grand Lake Mental Health Center, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D2176059) is associated with this NPI, valid through December 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Grand Lake Mental Health Center, Inc. accept?

Health plans from Blue Cross and Blue Shield of Oklahoma list Grand Lake Mental Health Center, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Grand Lake Mental Health Center, Inc. was last updated on June 13, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.