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NPI Code Detail

MEDICARE: COVENANT YOUTH AND FAMILY SERVICES

MEDICARE: COVENANT YOUTH AND FAMILY SERVICES
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
1251S00000XCommunity/Behavioral Health AgencyOK

General Provider Information

NPI Number : 1871811547
Entity Type Code : Organization
Provider Name (Legal Business Name) : COVENANT YOUTH AND FAMILY SERVICES
Provider Business Mailing Address
First Line : 3005 NW 63RD ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-3603
Country : US
Telephone Number : 405-521-1755
Fax Number : 405-521-1138
Provider Business Practice Location Address
First Line : 2408 PANTHEON CIR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73170-3236
Country : US
Telephone Number : 405-226-9593
Fax Number : 405-521-1138
Authorized Official
Title or Position : ADMINISTIVER DIRECTOR
Name : KATHRYN POULTER
Credential :
Telephone Number : 405-521-1755
Provider Enumeration Date : 05/05/2010
Last Update Date : 05/05/2010

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Directions to “COVENANT YOUTH AND FAMILY SERVICES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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