NPIMap

Organization Active NPI

Community Youth Services of Southern Oklahoma, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Ardmore, OK
National Provider Identifier
1003949439
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
COMMUNITY YOUTH SERVICES OF SOUTHERN OKLAHOMA, INC.
Practice address
830 Park St SE
Ardmore, OK 73401-8364
Phone
(580) 226-1838
Fax
(580) 223-7856
NPI assigned
Mar 14, 2007
Last updated
Jul 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kaylyn Dawn Weldon GaryNPI 1073835450
Title
Executive Director
Phone
(580) 226-1838

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

830 Park St SE
Ardmore, OK 73401-8364

Mailing address

830 Park St SE
Ardmore, OK 73401-8364
Phone (580) 226-1838

Other practice location 1

15 Monroe St NE
Ardmore, OK 73401-2025
Phone (580) 226-1838

Other identifiers 1

IdentifierTypeStateIssuer
100709510AMedicaidOK

National Provider Directory

National Provider Directory

Locations

15 Monroe St NE
Ardmore, OK 73401
Phone (580) 226-1838

830 Park St SE
Ardmore, OK 73401
Phone (580) 226-1838

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1003949439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 PARK ST SE",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734018364",
            "telephone_number": "580-226-1838",
            "fax_number": "580-223-7856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 PARK ST SE",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734018364",
            "telephone_number": "580-226-1838",
            "fax_number": "580-223-7856"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Monroe St NE",
            "address_purpose": "LOCATION",
            "city": "Ardmore",
            "state": "OK",
            "postal_code": "734012025",
            "country_code": "US",
            "telephone_number": "580-226-1838",
            "fax_number": "580-223-7856",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY YOUTH SERVICES OF SOUTHERN OKLAHOMA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "WELDON GARY",
        "authorized_official_first_name": "KAYLYN",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "580-226-1838"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100709510A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.