Provider Demographics
NPI:1083014781
Name:SOUTHWESTERN YOUTH SERVICES
Entity Type:Organization
Organization Name:SOUTHWESTERN YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-482-2809
Mailing Address - Street 1:123 W COMMERCE ST
Mailing Address - Street 2:#5
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-3850
Mailing Address - Country:US
Mailing Address - Phone:580-482-2809
Mailing Address - Fax:
Practice Address - Street 1:123 W COMMERCE ST
Practice Address - Street 2:#5
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3850
Practice Address - Country:US
Practice Address - Phone:580-482-2809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management