Healthcare Provider Details

I. General information

NPI: 1174770200
Provider Name (Legal Business Name): YCO CLINTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 S. MORGAN RD. SUITE D
YUKON OK
73099
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: 405-632-0038
Mailing address:
  • Phone: 866-926-6552
  • Fax: 405-632-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number100744460
License Number StateOK

VIII. Authorized Official

Name: MR. ROBERT LOBATO
Title or Position: OWNER/CEO
Credential: M.P.H.
Phone: 405-222-8167