Provider Demographics
NPI:1154651180
Name:COVENANT YOUTH & FAMILY SERVICES
Entity Type:Organization
Organization Name:COVENANT YOUTH & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:E.
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-942-0706
Mailing Address - Street 1:1812 N AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-2848
Mailing Address - Country:US
Mailing Address - Phone:405-942-0706
Mailing Address - Fax:
Practice Address - Street 1:1812 N AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2848
Practice Address - Country:US
Practice Address - Phone:405-942-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK742251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare