Provider Demographics
NPI:1023298874
Name:SMITH, MELISSA K (MS, LPC, NCC, CM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 CLINGMANS DOME RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6659
Mailing Address - Country:US
Mailing Address - Phone:405-399-3499
Mailing Address - Fax:270-837-9721
Practice Address - Street 1:122 E EUFAULA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6017
Practice Address - Country:US
Practice Address - Phone:405-447-4499
Practice Address - Fax:405-447-4419
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4747101YM0800X, 101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200409610BMedicaid