Provider Demographics
NPI:1457507428
Name:GREAT PLAINS YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:GREAT PLAINS YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-726-3383
Mailing Address - Street 1:901 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-1834
Mailing Address - Country:US
Mailing Address - Phone:580-726-3383
Mailing Address - Fax:580-726-3384
Practice Address - Street 1:901 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-1834
Practice Address - Country:US
Practice Address - Phone:580-726-3383
Practice Address - Fax:580-726-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100707910A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100707910AMedicaid