Organization
COMMUNITY YOUTH SERVICES OF SOUTHERN OKLAHOMA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAYLYN DAWN WELDON GARY (EXECUTIVE DIRECTOR)
(580) 226-1838
Entity
Organization
Contact information
Practice address
830 PARK ST SE, ARDMORE, OK 73401-8364
(580) 226-1838
(580) 223-7856
Mailing address
830 PARK ST SE, ARDMORE, OK 73401-8364
(580) 226-1838
(580) 223-7856
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100709510A
—
OK
Enumeration date
03/14/2007
Last updated
07/30/2024
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