MEDICARE: YCO TULSA, 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1669907580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YCO TULSA, INC

Provider Business Mailing Address
First Line	:	PO BOX 95207
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73143-5207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N GILBERT AVE
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-1023
Country	:	US
Telephone Number	:	918-289-0550
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT LOBATO
Credential	:
Telephone Number	:	866-926-6552

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	04/28/2017

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