Provider Demographics
NPI:1407087117
Name:SMITH, ANTOINE TERRELL
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:TERRELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 OLD BUGLE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6280
Mailing Address - Country:US
Mailing Address - Phone:405-210-9557
Mailing Address - Fax:
Practice Address - Street 1:616 OLD BUGLE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6280
Practice Address - Country:US
Practice Address - Phone:405-210-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor