Provider Demographics
NPI:1679832133
Name:SMITH, SHIREEN M (M ED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHIREEN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14453 SE 29TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-6543
Mailing Address - Country:US
Mailing Address - Phone:405-834-0620
Mailing Address - Fax:405-733-1334
Practice Address - Street 1:14453 SE 29TH ST STE D
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-6543
Practice Address - Country:US
Practice Address - Phone:405-834-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health