Healthcare Provider Details

I. General information

NPI: 1093006769
Provider Name (Legal Business Name): RACHEL DIANE YOUNG BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL DIANE MICHAEL

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E WYANDOTTE AVE
MCALESTER OK
74501-5427
US

IV. Provider business mailing address

727 E WYANDOTTE AVE
MCALESTER OK
74501-5427
US

V. Phone/Fax

Practice location:
  • Phone: 918-420-5343
  • Fax:
Mailing address:
  • Phone: 918-424-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: