Provider Demographics
NPI:1174770200
Name:YCO CLINTON, INC.
Entity type:Organization
Organization Name:YCO CLINTON, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:405-222-8167
Mailing Address - Street 1:PO BOX 95207
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-5207
Mailing Address - Country:US
Mailing Address - Phone:866-926-6552
Mailing Address - Fax:405-632-0038
Practice Address - Street 1:1312 S. MORGAN RD.
Practice Address - Street 2:SUITE D
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:405-632-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100744460251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744460Medicaid