MEDICARE: GIVE TO GIVE YOUTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1245929900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIVE TO GIVE YOUTH SERVICES

Provider Business Mailing Address
First Line	:	4717 S BRYANT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135
Country	:	US
Telephone Number	:	405-953-2574
Fax Number	:

Provider Business Practice Location Address
First Line	:	4717 S BRYANT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135
Country	:	US
Telephone Number	:	405-953-2574
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MELLISIA JONES
Credential	:
Telephone Number	:	405-953-2574

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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Directions to “GIVE TO GIVE YOUTH SERVICES ” Practice Location

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