Healthcare Provider Details

I. General information

NPI: 1326834540
Provider Name (Legal Business Name): LANNY JAY SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 CAMELOT DR
BARTLESVILLE OK
74006-7623
US

IV. Provider business mailing address

3650 CAMELOT DR
BARTLESVILLE OK
74006-7623
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-9050
  • Fax:
Mailing address:
  • Phone: 918-331-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number201449530
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: