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	100744460B	OK
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

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

General Provider Information

NPI Number	:	1891704060
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	:	866-926-6552
Fax Number	:	405-270-0543

Provider Business Practice Location Address
First Line	:	500 N 6TH ST
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-2422
Country	:	US
Telephone Number	:	580-309-7961
Fax Number	:

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

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	10/21/2020

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Directions to “YCO TULSA, INC ” Practice Location

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