Provider Demographics
NPI:1932478708
Name:MID-DEL YOUTH AND FAMILY CENTER
Entity Type:Organization
Organization Name:MID-DEL YOUTH AND FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-733-5437
Mailing Address - Street 1:1610 BLUE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-8053
Mailing Address - Country:US
Mailing Address - Phone:405-889-9526
Mailing Address - Fax:
Practice Address - Street 1:316 S MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4642
Practice Address - Country:US
Practice Address - Phone:405-733-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health