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General NPI Number Information
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NPI Number | 1235461641
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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 | 02/10/2010
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 120 S MADISON AVE
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City | ELK CITY
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State | OK
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Zip | 73644-5741
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Country | US
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Telephone | 580-660-5573
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Fax |
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Provider Business Mailing Address
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Address Line | 120 S MADISON AVE
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City | ELK CITY
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State | OK
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Zip | 73644-5741
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Country | US
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Telephone | 158-066-0557
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ROBERT LOBATO
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Credential | MBA
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Telephone | 18669266552
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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 | 734
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3990
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License Number State | OK
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