Provider Demographics
NPI:1285943886
Name:YOUTHCARE OF OKLAHOMA
Entity type:Organization
Organization Name:YOUTHCARE OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-842-8801
Mailing Address - Street 1:3035 NW 63RD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3606
Mailing Address - Country:US
Mailing Address - Phone:405-842-8801
Mailing Address - Fax:
Practice Address - Street 1:3035 NW 63RD ST STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3606
Practice Address - Country:US
Practice Address - Phone:405-842-8801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization