Provider Demographics
NPI:1871502047
Name:YCO TULSA, INC
Entity Type:Organization
Organization Name:YCO TULSA, INC
Other - Org Name:YOUTHCARE OF OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-926-6552
Mailing Address - Street 1:PO BOX 95207
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-5207
Mailing Address - Country:US
Mailing Address - Phone:866-926-6552
Mailing Address - Fax:580-547-4076
Practice Address - Street 1:1323 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2134
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100744460D101YP2500X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744460DMedicaid