MEDICARE: NEW LIFE YOUTH'S & FAMILY COUNSELING SERVICES, 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		OK

General Provider Information

NPI Number	:	1225151905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE YOUTH'S & FAMILY COUNSELING SERVICES, INC

Provider Business Mailing Address
First Line	:	6801 S WESTERN AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1816
Country	:	US
Telephone Number	:	405-605-5601
Fax Number	:	405-605-7914

Provider Business Practice Location Address
First Line	:	6801 S WESTERN AVE STE 200
Second Line	:	200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1816
Country	:	US
Telephone Number	:	405-605-5601
Fax Number	:	405-605-7914

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. CHRIS EJIOFOR
Credential	:
Telephone Number	:	405-605-5601

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/22/2020

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