Provider Demographics
NPI:1124395868
Name:BRIGGS FAMILY AND YOUTH ASSOCIATION
Entity Type:Organization
Organization Name:BRIGGS FAMILY AND YOUTH ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHABILITATION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DE'LICIA
Authorized Official - Middle Name:SHONTEZ
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-212-7335
Mailing Address - Street 1:1211 N SHARTEL AVENUE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103
Mailing Address - Country:US
Mailing Address - Phone:405-521-8635
Mailing Address - Fax:
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-521-8635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health