Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Grand Lake Therapeutics LLC

Organization Professional Counselor · NPI 1528670239

Grand Lake Therapeutics LLC is a Professional Counselor in Grove, Oklahoma. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1441 Lakeside Dr
Grove, OK 74344-4223
Phone: (918) 786-0875
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X

Record details

NPI number1528670239
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mitzy Kantor — Owner · (918) 786-0875
NPI enumeratedAugust 24, 2020
Last updated in NPPESAugust 24, 2020
Certification dateAugust 24, 2020
Mailing address1441 Lakeside Dr, Grove, OK 74344-4223

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