Healthcare Provider Details

I. General information

NPI: 1528345501
Provider Name (Legal Business Name): YCO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 E 41ST ST
TULSA OK
74135-6103
US

IV. Provider business mailing address

PO BOX 95207
OKLAHOMA CITY OK
73143-5207
US

V. Phone/Fax

Practice location:
  • Phone: 918-289-0550
  • Fax:
Mailing address:
  • Phone: 405-222-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberWTH1013331202
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT LOBATO
Title or Position: PRESIDENT
Credential: CPA
Phone: 405-222-8167