Provider Demographics
NPI:1184984262
Name:YOUNG, CHASITY M (BHRS)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BHRS
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 2207
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-2207
Mailing Address - Country:US
Mailing Address - Phone:580-421-5328
Mailing Address - Fax:
Practice Address - Street 1:705 W 13TH ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3712
Practice Address - Country:US
Practice Address - Phone:580-889-5555
Practice Address - Fax:580-889-1925
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040Medicaid