Provider Demographics
NPI:1881886125
Name:GOLDSMITH, JANIECE LEA (MSPS)
Entity type:Individual
Prefix:MRS
First Name:JANIECE
Middle Name:LEA
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MSPS
Other - Prefix:
Other - First Name:JANIECE
Other - Middle Name:LEA
Other - Last Name:HOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:OK
Mailing Address - Zip Code:73074
Mailing Address - Country:US
Mailing Address - Phone:405-207-8544
Mailing Address - Fax:
Practice Address - Street 1:204 MARK
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:OK
Practice Address - Zip Code:73074
Practice Address - Country:US
Practice Address - Phone:405-207-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional