Healthcare Provider Details

I. General information

NPI: 1114099355
Provider Name (Legal Business Name): MID-DEL YOUTH & FAMILY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 LINDA LN
DEL CITY OK
73115-5012
US

IV. Provider business mailing address

2840 LINDA LN
DEL CITY OK
73115-5012
US

V. Phone/Fax

Practice location:
  • Phone: 405-733-5437
  • Fax: 405-732-7741
Mailing address:
  • Phone: 405-733-5437
  • Fax: 405-732-7741

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: MRS. LISA COOPER
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 405-733-5437