Organization
FAMILY AND YOUTH INTERVENTION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RUSSELL BAINES (DIR)
(918) 852-4695
Entity
Organization
Contact information
Practice address
5037 S 24TH ST STE 2, PHOENIX, AZ 85040-2604
(602) 282-8836
Mailing address
PO BOX 842, OOLOGAH, OK 74053-0842
(188) 524-6959
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
OK
Other
Enumeration date
07/04/2010
Last updated
07/07/2020
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