Provider Demographics
NPI:1417234154
Name:SMITH, ALTON E JR (BHRS)
Entity Type:Individual
Prefix:MR
First Name:ALTON
Middle Name:E
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 ALDERSON RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-2186
Mailing Address - Country:US
Mailing Address - Phone:918-421-0922
Mailing Address - Fax:
Practice Address - Street 1:512 E CHICKASAW AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5354
Practice Address - Country:US
Practice Address - Phone:918-302-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor