Organization
MUSKOGEE COUNTY COUNCIL OF YOUTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACI KRISTINE RIDDLE LPC (PROGRAM DIRECTOR)
(918) 682-2841
Entity
Organization
Contact information
Practice address
4009 EUFAULA AVE, MUSKOGEE, OK 74403-1132
(918) 682-2841
(918) 686-6859
Mailing address
4009 EUFAULA AVE, MUSKOGEE, OK 74403-1132
(918) 682-2841
(918) 686-6859
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100730850
—
OK
Enumeration date
10/20/2006
Last updated
12/02/2010
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