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NPI Code Detail

MEDICARE: MRS. MICHELLE BERNADETTE SMITH LMHC

MEDICARE: MRS. MICHELLE BERNADETTE SMITH LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor7286OK

General Provider Information

NPI Number : 1336619683
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE BERNADETTE SMITH LMHC
Provider Business Mailing Address
First Line : 907 W CADDO ST
Second Line :
City : CLEVELAND
State : OK
Zip : 74020-4201
Country : US
Telephone Number : 918-308-5511
Fax Number :
Provider Business Practice Location Address
First Line : 907 W CADDO ST
Second Line :
City : CLEVELAND
State : OK
Zip : 74020-4201
Country : US
Telephone Number : 918-308-5511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2018
Last Update Date : 11/26/2019

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