Provider Demographics
NPI:1265801211
Name:SMITH, KENDRA (LMFT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6320
Mailing Address - Country:US
Mailing Address - Phone:580-224-2929
Mailing Address - Fax:
Practice Address - Street 1:333 W MAIN ST
Practice Address - Street 2:SUITE 260
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6326
Practice Address - Country:US
Practice Address - Phone:580-224-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1270101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor