Healthcare Provider Details

I. General information

NPI: 1932298320
Provider Name (Legal Business Name): SOUTHWESTERN YOUTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N HUDSON ST
ALTUS OK
73521-3709
US

IV. Provider business mailing address

PO BOX 175
ALTUS OK
73522-0175
US

V. Phone/Fax

Practice location:
  • Phone: 580-482-2809
  • Fax: 580-482-2820
Mailing address:
  • Phone: 580-482-2809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JUDIE M HANES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 580-482-2809