Provider Demographics
NPI:1275629057
Name:SMITH, RICHARD D (M ED, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:M ED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NW 159TH
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-341-2725
Mailing Address - Fax:405-341-2725
Practice Address - Street 1:500 NW 159TH
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-341-2725
Practice Address - Fax:405-341-2725
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2879OtherLPC LICENSE NO.
NC86326OtherNATL CERT COUNS NO.