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General NPI Number Information
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NPI Number | 1790612661
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Entity Type | Organization
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Legal Business Name | GRAND MENTAL HEALTH
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 405 E EXCELSIOR AVE
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City | VINITA
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State | OK
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Zip | 74301-4226
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Country | US
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Telephone | 800-722-3611
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Fax |
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Provider Business Mailing Address
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Address Line | 26730 S 670 RD
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City | GROVE
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State | OK
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Zip | 74344-6278
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Country | US
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Telephone | 800-722-3611
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Fax |
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Authorized Official
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Title or Position | PEER RECOVERY SUPPORT SPECIALIST
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Name | MR. DALLAS BLAKE DEMPSEY
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Credential |
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Telephone | 918-815-5944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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