Healthcare Provider Details

I. General information

NPI: 1972884096
Provider Name (Legal Business Name): LAURA ANN ROGERS-SMITH BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 HIGHWAY 70 E
MEAD OK
73449
US

IV. Provider business mailing address

402 PARK ST SE APT 14B
ARDMORE OK
73401-8368
US

V. Phone/Fax

Practice location:
  • Phone: 580-745-9083
  • Fax: 580-745-9885
Mailing address:
  • Phone: 580-220-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: