Healthcare Provider Details

I. General information

NPI: 1467525105
Provider Name (Legal Business Name): AGENCY FOR YOUTH AND FAMILY DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 DESKIN DR
NORMAN OK
73069-8295
US

IV. Provider business mailing address

3400 DESKIN DR
NORMAN OK
73069-8295
US

V. Phone/Fax

Practice location:
  • Phone: 405-701-1522
  • Fax: 405-701-8531
Mailing address:
  • Phone: 405-701-1522
  • Fax: 405-701-8531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. ROBERT CORNELIUS
Title or Position: VPO
Credential:
Phone: 405-701-1522