MEDICARE: DR. DAN MICHAEL SMITH PH.D.

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
1	103TC0700X	Clinical Psychologist	212	OK
2	106H00000X	Marriage & Family Therapist	525	OK

General Provider Information

NPI Number	:	1720014814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN MICHAEL SMITH PH.D.

Provider Business Mailing Address
First Line	:	15 SHERMAN LN
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-5724
Country	:	US
Telephone Number	:	580-765-9973
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 FAIRVIEW AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1924
Country	:	US
Telephone Number	:	580-765-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	09/11/2025

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