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General NPI Number Information
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NPI Number | 1528377066
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Entity Type | Individual
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Provider Name | LISA YOUNG BA/BHCM
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Gender | Female
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 12880 NS 358 RD
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City | SEMINOLE
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State | OK
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Zip | 74868
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Country | US
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Telephone | 405-380-5986
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 81 12880 NS 358
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City | BOWLEGS
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State | OK
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Zip | 74830-0081
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Country | US
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Telephone | 405-380-5986
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 20996
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License Number State | OK
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