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General NPI Number Information
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NPI Number | 1174770200
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Entity Type | Organization
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Legal Business Name | YCO CLINTON, INC.
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 1312 S. MORGAN RD. SUITE D
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City | YUKON
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State | OK
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Zip | 73099
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Country | US
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Telephone | 866-926-6552
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Fax | 405-632-0038
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Provider Business Mailing Address
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Address Line | PO BOX 95207
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City | OKLAHOMA CITY
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State | OK
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Zip | 73143-5207
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Country | US
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Telephone | 866-926-6552
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Fax | 405-632-0038
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. ROBERT LOBATO
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Credential | M.P.H.
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Telephone | 405-222-8167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 100744460
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License Number State | OK
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