Provider Demographics
NPI:1417341603
Name:SMITH, SELEENA DAWN (MED, PHD)
Entity Type:Individual
Prefix:DR
First Name:SELEENA
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 W HILL ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7355
Mailing Address - Country:US
Mailing Address - Phone:202-413-7051
Mailing Address - Fax:
Practice Address - Street 1:5929 N MAY AVE STE 302
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3925
Practice Address - Country:US
Practice Address - Phone:405-842-0500
Practice Address - Fax:405-842-0505
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling