| Organization Name: | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| NPI Number: | 1003292061 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES DANLEY (CEO) |
| Mailing Address: | 413 Se Frank Phillips Suite 101 Bartlesville |
| State: | OK US |
| Postal Code: | 740033606 |
| Phone Number: | 9183378080 |
| Fax Number: | 9188766431 |
| NPI Enumeration Date: | 07/31/2015 |
| NPI Last Update Date: | 09/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |