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GRAND MENTAL HEALTH
NPI 1578103206
Clinic/Center - Mental Health (Including Community Mental Health Center) in Jay, OK

Active since January 10, 2020
1015 W WASHBOURNE ST, JAY, OK 74346(918) 305-5513(918) 253-6645 Get Directions Write a Review

NPPES record last updated: June 13, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Grand Mental Health NPPES

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

GRAND MENTAL HEALTH (NPI 1578103206) is a healthcare organization registered as a mental health (including community mental health center) in Jay, Oklahoma and active in the NPI registry since January 2020. The organization lists Larry Smith, Ceo, as its authorized official.

NPPES Registry Identity

NPI1578103206
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) 305-5513
Fax(918) 253-6645
Organization SubpartNo
Authorized OfficialLarry SmithCeo · (918) 273-1841
Enumeration DateJanuary 10, 2020
Last NPPES UpdateJune 13, 2022
NPPES CertifiedJune 13, 2022
✔ NPI 1578103206 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
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Other Names 1

Doing Business AsGrand Mental Health

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 1578103206. It was assigned to this organization in the NPPES registry on January 10, 2020. 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) 305-5513.

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.

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.