Provider Demographics
NPI:1477600427
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:YOUTH & FAMILY SERVICES OF NCO
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BOOKOUT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:580-233-7220
Mailing Address - Street 1:605 W. OXFORD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-1256
Mailing Address - Country:US
Mailing Address - Phone:580-233-7220
Mailing Address - Fax:580-237-7550
Practice Address - Street 1:605 W. OXFORD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-1256
Practice Address - Country:US
Practice Address - Phone:580-233-7220
Practice Address - Fax:580-237-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100731500DMedicaid