Provider Demographics
NPI:1669672234
Name:SMITH, RAEGAN B (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAEGAN
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:RAEGAN
Other - Middle Name:B
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3750 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4657
Mailing Address - Country:US
Mailing Address - Phone:405-801-2835
Mailing Address - Fax:405-801-2835
Practice Address - Street 1:3750 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4657
Practice Address - Country:US
Practice Address - Phone:405-801-2835
Practice Address - Fax:405-801-2835
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical