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General NPI Number Information
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NPI Number | 1174385900
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Entity Type | Organization
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Legal Business Name | SISU YOUTH, INC.
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 2129 NW 30TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7901
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Country | US
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Telephone | 405-459-7478
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 N PENNSYLVANIA AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7931
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Country | US
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Telephone | 405-589-5709
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Fax |
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Authorized Official
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Title or Position | CLINICAL SERVICES MANAGER
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Name | MRS. MEAGAN KAYE MATHIS
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Credential | LPC
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Telephone | 405-589-5709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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