Provider Demographics
NPI:1225165343
Name:PIVOT, INC.
Entity Type:Organization
Organization Name:PIVOT, INC.
Other - Org Name:YOUTH SERVICES FOR OKLAHOMA COUNTY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SCHMIDT - GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LADC
Authorized Official - Phone:404-235-7537
Mailing Address - Street 1:201 NE 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1811
Mailing Address - Country:US
Mailing Address - Phone:405-235-7537
Mailing Address - Fax:405-528-5754
Practice Address - Street 1:201 NE 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1811
Practice Address - Country:US
Practice Address - Phone:405-235-7537
Practice Address - Fax:405-528-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100707820AMedicaid