MEDICARE: MID-DEL YOUTH & FAMILY CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114099355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-DEL YOUTH & FAMILY CENTER, INC.

Provider Business Mailing Address
First Line	:	2840 LINDA LN
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5012
Country	:	US
Telephone Number	:	405-733-5437
Fax Number	:	405-732-7741

Provider Business Practice Location Address
First Line	:	2840 LINDA LN
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5012
Country	:	US
Telephone Number	:	405-733-5437
Fax Number	:	405-732-7741

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. LISA COOPER
Credential	:	LPC
Telephone Number	:	405-733-5437

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	02/05/2024

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