Provider Demographics
NPI:1225351521
Name:MCCLEARYSMITH, KIMBERLY CAROL (CASEMANAGER, BHRS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CAROL
Last Name:MCCLEARYSMITH
Suffix:
Gender:F
Credentials:CASEMANAGER, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 NE 47TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-2007
Mailing Address - Country:US
Mailing Address - Phone:405-833-6876
Mailing Address - Fax:
Practice Address - Street 1:316 S MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4642
Practice Address - Country:US
Practice Address - Phone:405-733-5437
Practice Address - Fax:405-732-7441
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst