Provider Demographics
NPI:1760508006
Name:COVENANT YOUTH & FAMILY SERVICES
Entity Type:Organization
Organization Name:COVENANT YOUTH & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NSIKAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-623-1117
Mailing Address - Street 1:3813 N SANTA FE AVE
Mailing Address - Street 2:SUITE 131
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-8508
Mailing Address - Country:US
Mailing Address - Phone:405-521-1755
Mailing Address - Fax:405-521-1138
Practice Address - Street 1:3813 N SANTA FE AVE
Practice Address - Street 2:SUITE 131
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-8508
Practice Address - Country:US
Practice Address - Phone:405-521-1755
Practice Address - Fax:405-521-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)