Provider Demographics
NPI:1811375306
Name:YORK, CHAD IRVIN
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:IRVIN
Last Name:YORK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BIG CABIN
Mailing Address - State:OK
Mailing Address - Zip Code:74332-0129
Mailing Address - Country:US
Mailing Address - Phone:918-418-9185
Mailing Address - Fax:
Practice Address - Street 1:33200 S 625 RD
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-5398
Practice Address - Country:US
Practice Address - Phone:918-418-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)