Provider Demographics
NPI:1972884096
Name:ROGERS-SMITH, LAURA ANN (BHRS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:ROGERS-SMITH
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 PARK ST SE APT 14B
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-8368
Mailing Address - Country:US
Mailing Address - Phone:580-220-8850
Mailing Address - Fax:
Practice Address - Street 1:5912 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:OK
Practice Address - Zip Code:73449
Practice Address - Country:US
Practice Address - Phone:580-745-9083
Practice Address - Fax:580-745-9885
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040Medicaid