Healthcare Provider Details

I. General information

NPI: 1205955226
Provider Name (Legal Business Name): MULTI-COUNTY YOUTH AND FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 AVANT AVE
CLINTON OK
73601-3916
US

IV. Provider business mailing address

600 AVANT AVE P.O. BOX 104
CLINTON OK
73601-3916
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-3322
  • Fax: 580-323-6233
Mailing address:
  • Phone: 580-323-3322
  • Fax: 580-323-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JERRY BEECH
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 580-323-3322