Provider Demographics
NPI:1164714044
Name:YOUTH AND FAMILY SERVICES OF NORTH CENTRAL OKLAHOMA, INC.
Entity Type:Organization
Organization Name:YOUTH AND FAMILY SERVICES OF NORTH CENTRAL OKLAHOMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NALL
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:580-603-1166
Mailing Address - Street 1:2112 W PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4134
Mailing Address - Country:US
Mailing Address - Phone:580-603-1166
Mailing Address - Fax:
Practice Address - Street 1:2112 W PINE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4134
Practice Address - Country:US
Practice Address - Phone:580-603-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty