Provider Demographics
NPI:1629708078
Name:SMITH, MACKINZEE LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:MACKINZEE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MACKINZEE
Other - Middle Name:LYNN
Other - Last Name:SLATTERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1005 NW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7117
Mailing Address - Country:US
Mailing Address - Phone:405-474-9150
Mailing Address - Fax:
Practice Address - Street 1:2113 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1505
Practice Address - Country:US
Practice Address - Phone:405-840-9000
Practice Address - Fax:405-840-9017
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8585-P1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical