Provider Demographics
NPI:1073723417
Name:WESTERN PLAINS YOUTH & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:WESTERN PLAINS YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-254-5322
Mailing Address - Street 1:1213 W HANKS TRAIL
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-7601
Mailing Address - Country:US
Mailing Address - Phone:580-254-5322
Mailing Address - Fax:580-256-1063
Practice Address - Street 1:5 SW D AVE, STE. B
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4619
Practice Address - Country:US
Practice Address - Phone:580-248-3065
Practice Address - Fax:580-248-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKK860076251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732920FMedicaid