Provider Demographics
NPI:1871057125
Name:WILLOW YOUTH MENTAL HEALTH
Entity type:Organization
Organization Name:WILLOW YOUTH MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-400-1152
Mailing Address - Street 1:2782 WASHINGTON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-1013
Mailing Address - Country:US
Mailing Address - Phone:405-400-1152
Mailing Address - Fax:405-217-4383
Practice Address - Street 1:2782 WASHINGTON DR STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1013
Practice Address - Country:US
Practice Address - Phone:405-400-1152
Practice Address - Fax:405-217-4383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty