Healthcare Provider Details

I. General information

NPI: 1598975930
Provider Name (Legal Business Name): WESTERN PLAINS YOUTH & FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 W HANKS TRAIL
WOODWARD OK
73801-7601
US

IV. Provider business mailing address

1213 W HANKS TRAIL
WOODWARD OK
73801-7601
US

V. Phone/Fax

Practice location:
  • Phone: 580-254-5322
  • Fax: 580-254-5335
Mailing address:
  • Phone: 580-256-3157
  • Fax: 580-256-1063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberK860000076
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberK860076
License Number StateOK

VIII. Authorized Official

Name: MR. KEVIN EVANS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 580-254-5322