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General NPI Number Information
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NPI Number | 1235419870
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Entity Type | Organization
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Legal Business Name | FAMILY AND YOUTH INTERVENTIONS SERVICES
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 4444 S 109TH EAST AVE 220
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City | TULSA
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State | OK
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Zip | 74146-5368
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Country | US
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Telephone | 918-951-1539
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Fax |
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Provider Business Mailing Address
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Address Line | 4444 S 109TH EAST AVE
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City | TULSA
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State | OK
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Zip | 74146-5368
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Country | US
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Telephone | 918-951-1539
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MS. TRACYE LOVE
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Credential | LPN
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Telephone | 918-810-6852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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