| Community Youth Services Of Southern Oklahoma, Inc. | |
|
830 Park St Se Ardmore OK 73401-8364 | |
| (580) 226-1838 | |
| (580) 223-7856 |
| Full Name | Community Youth Services Of Southern Oklahoma, Inc. |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 830 Park St Se, Ardmore, Oklahoma |
| Authorized Official Name and Position | Kaylyn Dawn Weldon Gary (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5802261838 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Youth Services Of Southern Oklahoma, Inc. 830 Park St Se Ardmore OK 73401-8364 Ph: (580) 226-1838 | Community Youth Services Of Southern Oklahoma, Inc. 830 Park St Se Ardmore OK 73401-8364 Ph: (580) 226-1838 |
| NPI Number | 1003949439 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 07/30/2024 |
| Certification Date | 07/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003949439 | NPI | - | NPPES |
| 100709510A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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