Provider Demographics
NPI:1700907730
Name:LEFLORE COUNTY YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:LEFLORE COUNTY YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-647-4196
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0711
Mailing Address - Country:US
Mailing Address - Phone:918-647-4196
Mailing Address - Fax:918-647-5741
Practice Address - Street 1:320 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4212
Practice Address - Country:US
Practice Address - Phone:918-647-4196
Practice Address - Fax:918-647-5741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health