Healthcare Provider Details

I. General information

NPI: 1285943886
Provider Name (Legal Business Name): YOUTHCARE OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 NW 63RD ST STE 201
OKLAHOMA CITY OK
73116-3606
US

IV. Provider business mailing address

3035 NW 63RD ST STE 201
OKLAHOMA CITY OK
73116-3606
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-8801
  • Fax:
Mailing address:
  • Phone: 405-842-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA PARKER
Title or Position: DIRECTOR
Credential: LPC
Phone: 405-842-8801