Provider Demographics
NPI:1205183548
Name:SMITH, TATIANA SHERELLE
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:SHERELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 N BOSTON PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-2208
Mailing Address - Country:US
Mailing Address - Phone:918-720-9756
Mailing Address - Fax:
Practice Address - Street 1:2616 N BOSTON PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-2208
Practice Address - Country:US
Practice Address - Phone:918-720-9756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health