Provider Demographics
NPI:1194199968
Name:YCO TULSA
Entity Type:Organization
Organization Name:YCO TULSA
Other - Org Name:YOUTHCARE OF OKLAHOMA - TULSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-289-0550
Mailing Address - Street 1:PO BOX 95207
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-5207
Mailing Address - Country:US
Mailing Address - Phone:866-926-6552
Mailing Address - Fax:918-289-0551
Practice Address - Street 1:1809 COMMOMS CIRCLE, SUITE B
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5787
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:918-289-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200333190Medicaid