Provider Demographics
NPI:1497959399
Name:YOUTH SERVICES FOR STEPHENS COUNTY, INC.
Entity Type:Organization
Organization Name:YOUTH SERVICES FOR STEPHENS COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERDT
Authorized Official - Suffix:
Authorized Official - Credentials:MCJA
Authorized Official - Phone:580-255-8800
Mailing Address - Street 1:16 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4940
Mailing Address - Country:US
Mailing Address - Phone:580-255-8800
Mailing Address - Fax:580-255-8842
Practice Address - Street 1:16 S 7TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4940
Practice Address - Country:US
Practice Address - Phone:580-255-8800
Practice Address - Fax:580-255-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK160101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty