Provider Demographics
NPI:1114099355
Name:MID-DEL YOUTH & FAMILY CENTER, INC.
Entity Type:Organization
Organization Name:MID-DEL YOUTH & FAMILY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-733-5437
Mailing Address - Street 1:2840 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-5012
Mailing Address - Country:US
Mailing Address - Phone:405-733-5437
Mailing Address - Fax:405-732-7741
Practice Address - Street 1:2840 LINDA LN
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-5012
Practice Address - Country:US
Practice Address - Phone:405-733-5437
Practice Address - Fax:405-732-7741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100740990BMedicaid
OK100740990CMedicaid
OK100740990AMedicaid