Provider Demographics
NPI:1437576964
Name:SMITH, MARRIE
Entity Type:Individual
Prefix:
First Name:MARRIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARRIE
Other - Middle Name:
Other - Last Name:DUBOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 S MURPHY ST
Mailing Address - Street 2:APT#17205
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1586
Mailing Address - Country:US
Mailing Address - Phone:405-838-0371
Mailing Address - Fax:
Practice Address - Street 1:920 S MURPHY ST
Practice Address - Street 2:APT#17205
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1586
Practice Address - Country:US
Practice Address - Phone:405-838-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst