Healthcare Provider Details

I. General information

NPI: 1982064226
Provider Name (Legal Business Name): YCO TULSA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 E STEVE OWENS BLVD
MIAMI OK
74354
US

IV. Provider business mailing address

PO BOX 95207
OKLAHOMA CITY OK
73143-5207
US

V. Phone/Fax

Practice location:
  • Phone: 866-926-6552
  • Fax: 580-547-4076
Mailing address:
  • Phone: 866-926-6552
  • 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: ROBERT LOBATO
Title or Position: CEO
Credential:
Phone: 866-926-9552