Healthcare Provider Details

I. General information

NPI: 1225337025
Provider Name (Legal Business Name): KAYLA D. SMITH M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD SUITE 214
OKLAHOMA CITY OK
73106-6835
US

IV. Provider business mailing address

5925 NE 63RD ST
OKLAHOMA CITY OK
73141-9655
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6710
  • Fax: 405-601-6711
Mailing address:
  • Phone: 405-771-9905
  • Fax: 405-771-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: