Provider Demographics
NPI:1710109178
Name:NORTHERN OKLAHOMA YOUTH SERVICES
Entity Type:Organization
Organization Name:NORTHERN OKLAHOMA YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-761-2269
Mailing Address - Street 1:2203 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1108
Mailing Address - Country:US
Mailing Address - Phone:580-762-8341
Mailing Address - Fax:580-762-9967
Practice Address - Street 1:2203 N ASH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1108
Practice Address - Country:US
Practice Address - Phone:580-762-8341
Practice Address - Fax:580-762-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health