Provider Demographics
NPI:1992053755
Name:VICTORY YOUTH COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:VICTORY YOUTH COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:405-821-5133
Mailing Address - Street 1:5350 S WESTERN AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-4520
Mailing Address - Country:US
Mailing Address - Phone:405-631-9991
Mailing Address - Fax:405-631-9850
Practice Address - Street 1:5350 S WESTERN AVE
Practice Address - Street 2:707
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4520
Practice Address - Country:US
Practice Address - Phone:405-631-9991
Practice Address - Fax:405-631-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health