Healthcare Provider Details

I. General information

NPI: 1053430231
Provider Name (Legal Business Name): YOUTH AND FAMILY SERVICES OF NORTH CENTRAL OKLAHOMA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 MIDWAY ST
ENID OK
73701-1256
US

IV. Provider business mailing address

2529 MIDWAY ST
ENID OK
73701-2132
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-7220
  • Fax: 580-237-7550
Mailing address:
  • Phone: 580-233-7220
  • 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: LINDA L WAGGONER
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 580-233-7220