Provider Demographics
NPI:1083932743
Name:SMITH, TRENT W (BA)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 NE 10TH ST
Mailing Address - Street 2:APT. 303
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3658
Mailing Address - Country:US
Mailing Address - Phone:405-501-6776
Mailing Address - Fax:
Practice Address - Street 1:214 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-6506
Practice Address - Country:US
Practice Address - Phone:405-272-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK082666747OtherREHABILITATION COUNSELOR