Provider Demographics
NPI:1932298320
Name:SOUTHWESTERN YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHWESTERN YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-482-2809
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-0175
Mailing Address - Country:US
Mailing Address - Phone:580-482-2809
Mailing Address - Fax:
Practice Address - Street 1:309 N HUDSON ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3709
Practice Address - Country:US
Practice Address - Phone:580-482-2809
Practice Address - Fax:580-482-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health