Provider Demographics
NPI:1891016960
Name:SMITH, CHAROLETTE KAY (LPC)
Entity Type:Individual
Prefix:
First Name:CHAROLETTE
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30786 S COUNTY ROAD 4380
Mailing Address - Street 2:
Mailing Address - City:KINTA
Mailing Address - State:OK
Mailing Address - Zip Code:74552-3060
Mailing Address - Country:US
Mailing Address - Phone:918-448-0095
Mailing Address - Fax:
Practice Address - Street 1:30786 S COUNTY ROAD 4380
Practice Address - Street 2:
Practice Address - City:KINTA
Practice Address - State:OK
Practice Address - Zip Code:74552-3060
Practice Address - Country:US
Practice Address - Phone:918-448-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional