Healthcare Provider Details

I. General information

NPI: 1013620244
Provider Name (Legal Business Name): ARLY SMART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9908 N. KELLEY AVE
OKLAHOMA CITY OK
73131
US

IV. Provider business mailing address

9008 N KELLEY AVE
OKLAHOMA CITY OK
73131-2428
US

V. Phone/Fax

Practice location:
  • Phone: 405-596-1333
  • Fax:
Mailing address:
  • Phone: 405-596-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11917
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: