Provider Demographics
NPI:1265853584
Name:SMITH, JONEICE
Entity Type:Individual
Prefix:
First Name:JONEICE
Middle Name:
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 1:502 E VILAS AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-5131
Mailing Address - Country:US
Mailing Address - Phone:405-509-4366
Mailing Address - Fax:
Practice Address - Street 1:502 E VILAS AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5131
Practice Address - Country:US
Practice Address - Phone:405-509-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-05
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor