Provider Demographics
NPI:1528514890
Name:YOUTH AND FAMILY RESOURCE CENTER
Entity type:Organization
Organization Name:YOUTH AND FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UTTERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-275-3340
Mailing Address - Street 1:326 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801
Mailing Address - Country:US
Mailing Address - Phone:405-275-3340
Mailing Address - Fax:
Practice Address - Street 1:326 W 11TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801
Practice Address - Country:US
Practice Address - Phone:405-275-3340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)