Healthcare Provider Details

I. General information

NPI: 1780915157
Provider Name (Legal Business Name): COVENANT YOUTH AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2010
Last Update Date: 01/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 NW 63RD ST
OKLAHOMA CITY OK
73116-3603
US

IV. Provider business mailing address

3005 NW 63RD ST
OKLAHOMA CITY OK
73116-3603
US

V. Phone/Fax

Practice location:
  • Phone: 405-521-1755
  • Fax:
Mailing address:
  • Phone: 405-521-1755
  • 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: MS. PENNI MARIE LANCASTER
Title or Position: THERAPIST
Credential: MA
Phone: 405-532-1996