Healthcare Provider Details

I. General information

NPI: 1427797927
Provider Name (Legal Business Name): JA'LEESA T GILES SMITHERMAN MCMHC, LPC CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JALEESA GILES MCMHC, LPC CANDIDATE

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NW 5TH ST STE D
MOORE OK
73160-3947
US

IV. Provider business mailing address

2501 PENDLETON DR APT 1814
NORMAN OK
73072-3469
US

V. Phone/Fax

Practice location:
  • Phone: 405-208-4469
  • Fax:
Mailing address:
  • Phone: 682-208-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCCANDIDATE12557
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: