Organization
COMMUNITY IMPACT YOUTH & FAMILY SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRENDA D PATTERSON MS, LPC/LADC (EXECUTIVE DIRECTOR)
(405) 455-6738
Entity
Organization
Contact information
Practice address
4909 SE 86TH TER, OKLAHOMA CITY, OK 73135-6315
(405) 455-6738
Mailing address
7901 NE 10TH ST STE B103, MIDWEST CITY, OK 73110-3653
(405) 455-6738
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
OK
251S00000X
Community/Behavioral Health Agency
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103K00000X
—
OK
Enumeration date
07/16/2015
Last updated
07/16/2015
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