Healthcare Provider Details

I. General information

NPI: 1932478708
Provider Name (Legal Business Name): MID-DEL YOUTH AND FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S MIDWEST BLVD
MIDWEST CITY OK
73110-4642
US

IV. Provider business mailing address

1610 BLUE LAKE DR
NORMAN OK
73069-8053
US

V. Phone/Fax

Practice location:
  • Phone: 405-733-5437
  • Fax:
Mailing address:
  • Phone: 405-889-9526
  • 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: MR. JEREMY WENTE
Title or Position: EXEC. DIRECTOR
Credential: LCSW
Phone: 405-733-5437