Healthcare Provider Details

I. General information

NPI: 1881886125
Provider Name (Legal Business Name): JANIECE LEA GOLDSMITH MSPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANIECE LEA HOLTZ LPC

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MARK
PAOLI OK
73074
US

IV. Provider business mailing address

PO BOX 145
PAOLI OK
73074
US

V. Phone/Fax

Practice location:
  • Phone: 405-207-8544
  • Fax:
Mailing address:
  • Phone: 405-207-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4665
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: