Healthcare Provider Details

I. General information

NPI: 1235461641
Provider Name (Legal Business Name): YCO CLINTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MADISON AVE
ELK CITY OK
73644-5741
US

IV. Provider business mailing address

120 S MADISON AVE
ELK CITY OK
73644-5741
US

V. Phone/Fax

Practice location:
  • Phone: 580-660-5573
  • Fax:
Mailing address:
  • Phone: 158-066-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number734
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3990
License Number StateOK

VIII. Authorized Official

Name: ROBERT LOBATO
Title or Position: CFO
Credential: MBA
Phone: 18669266552