Provider Demographics
NPI:1528418795
Name:YUKON PEDIATRICS BEHAVIORAL HEALTH L.L.C.
Entity Type:Organization
Organization Name:YUKON PEDIATRICS BEHAVIORAL HEALTH L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-265-2655
Mailing Address - Street 1:508 W VANDAMENT AVE
Mailing Address - Street 2:STE. 207
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4655
Mailing Address - Country:US
Mailing Address - Phone:405-265-2655
Mailing Address - Fax:405-350-0024
Practice Address - Street 1:508 W VANDAMENT AVE
Practice Address - Street 2:STE. 207
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4655
Practice Address - Country:US
Practice Address - Phone:405-265-2655
Practice Address - Fax:405-350-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health