Provider Demographics
NPI:1093146656
Name:SMITH, STEFANIE DANIELLE (MED)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:DANIELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:STEFANIE
Other - Middle Name:DANIELLE
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M ED
Mailing Address - Street 1:4343 COUNTY ROAD 4500
Mailing Address - Street 2:
Mailing Address - City:SHIDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74652-5211
Mailing Address - Country:US
Mailing Address - Phone:580-716-2771
Mailing Address - Fax:
Practice Address - Street 1:4343 COUNTY ROAD 4500
Practice Address - Street 2:
Practice Address - City:SHIDLER
Practice Address - State:OK
Practice Address - Zip Code:74652-5211
Practice Address - Country:US
Practice Address - Phone:580-716-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health