Healthcare Provider Details

I. General information

NPI: 1134497449
Provider Name (Legal Business Name): GARY AUSTIN SMITH BHRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 NW 39TH SUITE 103
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

2401 NW 39TH SUITE 103
OKLAHOMA CITY OK
73112
US

V. Phone/Fax

Practice location:
  • Phone: 405-557-1655
  • Fax: 405-525-0677
Mailing address:
  • Phone: 405-557-1655
  • Fax: 405-525-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: