Healthcare Provider Details

I. General information

NPI: 1164956306
Provider Name (Legal Business Name): YCO TULSA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 E 71ST ST STE A
TULSA OK
74136-5576
US

IV. Provider business mailing address

PO BOX 95207
OKLAHOMA CITY OK
73143-5207
US

V. Phone/Fax

Practice location:
  • Phone: 866-926-6552
  • Fax: 580-547-4076
Mailing address:
  • Phone: 866-926-6552
  • Fax: 580-547-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: D'FAWN DOWNS
Title or Position: CCO
Credential: M.ED., LPC
Phone: 580-383-7608