Provider Demographics
NPI:1831231422
Name:SMITH, EMILIE JEAN (LPC)
Entity type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:EMILIE
Other - Middle Name:JEAN
Other - Last Name:WADDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-633-2339
Mailing Address - Fax:
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-748-9868
Practice Address - Fax:918-748-9835
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3594101YP2500X
ORC1125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional