Provider Demographics
NPI:1982901096
Name:YOUTHCARE OF OKLAHOMA
Entity Type:Organization
Organization Name:YOUTHCARE OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTREACH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KEYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADEN-TESAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-289-0550
Mailing Address - Street 1:6301 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6103
Mailing Address - Country:US
Mailing Address - Phone:918-289-0550
Mailing Address - Fax:
Practice Address - Street 1:6301 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6103
Practice Address - Country:US
Practice Address - Phone:918-289-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health