Healthcare Provider Details

I. General information

NPI: 1659617488
Provider Name (Legal Business Name): YCO WEST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E US HIGHWAY 66
EL RENO OK
73036-5787
US

IV. Provider business mailing address

PO BOX 95207
OKLAHOMA CITY OK
73143-5207
US

V. Phone/Fax

Practice location:
  • Phone: 405-262-2229
  • Fax: 405-262-2229
Mailing address:
  • Phone: 580-383-7608
  • Fax: 580-547-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT LOBATO
Title or Position: CEO
Credential:
Phone: 405-222-8167