Provider Demographics
NPI:1629272364
Name:CITIZEN'S ADVISORY COMMITTEE FOR PITTSBURG COUNTY YOUTH EMERGENCY SHEL
Entity Type:Organization
Organization Name:CITIZEN'S ADVISORY COMMITTEE FOR PITTSBURG COUNTY YOUTH EMERGENCY SHEL
Other - Org Name:YOUTH EMERGENCY SHELTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:918-423-8845
Mailing Address - Street 1:904 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4212
Mailing Address - Country:US
Mailing Address - Phone:918-423-8845
Mailing Address - Fax:918-423-8898
Practice Address - Street 1:107 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-3052
Practice Address - Country:US
Practice Address - Phone:918-689-2900
Practice Address - Fax:918-689-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health