Provider Demographics
NPI:1447594502
Name:EASTERN OKLAHOMA YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:EASTERN OKLAHOMA YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-420-5325
Mailing Address - Street 1:2626 S 14TH ST
Mailing Address - Street 2:SUITE A20
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7383
Mailing Address - Country:US
Mailing Address - Phone:918-420-5325
Mailing Address - Fax:918-420-5327
Practice Address - Street 1:511 COLLEGE CT
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4747
Practice Address - Country:US
Practice Address - Phone:918-453-0600
Practice Address - Fax:918-453-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health