Basic Information
| Provider Information | |||||||||
| NPI: | 1124395868 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRIGGS FAMILY AND YOUTH ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 N SHARTEL AVENUE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055218635 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1211 N SHARTEL AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731032400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055218635 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2011 | ||||||||
| LastUpdateDate: | 11/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | BURRELL | ||||||||
| AuthorizedOfficialFirstName: | DE'LICIA | ||||||||
| AuthorizedOfficialMiddleName: | SHONTEZ | ||||||||
| AuthorizedOfficialTitleorPosition: | REHABILITATION SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5802127335 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 103K00000X | OK | Y | Agencies | Community/Behavioral Health |
No ID Information.