| NPI | 1053317883 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2005-06-27 |
| Last Updated | 2025-10-17 |
| Authorized Official | Joshua Cantwell CEO Phone: 9182731841 |
| Mailing Address | 114 W Delaware Ave Nowata, OK 74048-2601 United States Phone: (918) 273-1841 | Fax: (918) 273-1843 📍 View Map |
| Primary Practice Address | 6333 E Skelly Dr Tulsa, OK 74135-6106 United States Phone: (918) 664-4224 | Fax: (918) 663-0203 📍 View Map |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| No | 324500000X – Substance Abuse Rehabilitation Facility | OK | 640AD |
| Yes | 251S00000X – Community/Behavioral Health | - | - |
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About NPI 1053317883
Grand Lake Mental Health Center, Inc. is an organization registered in the CMS NPPES NPI Registry with NPI number 1053317883. The primary specialty listed is Community/Behavioral Health. The organization is located in Tulsa, OK. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2005-06-27. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1053317883?
NPI 1053317883 belongs to Grand Lake Mental Health Center, Inc., a Community/Behavioral Health in Tulsa, OK. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1053317883 active?
The current status of NPI 1053317883 in the NPPES registry is Active. The record was last updated on 2025-10-17.
What specialty is NPI 1053317883?
NPI 1053317883 is classified under the taxonomy Community/Behavioral Health. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1053317883?
You can verify NPI 1053317883 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1053317883?
The primary practice address on file for NPI 1053317883 is 6333 E Skelly Dr, Tulsa, OK 74135-6106. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1053317883 issued?
NPI 1053317883 was first issued (enumerated) on 2005-06-27. The NPPES record was last updated on 2025-10-17.
Practice Location Map
Grand Lake Mental Health Center, Inc. is located at 6333 E Skelly Dr, Tulsa, OK. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Grand Lake Mental Health Center, Inc.. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1053317883. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Substance Abuse Rehabilitation Facility | 640AD | OK |