Healthcare Provider Details

I. General information

NPI: 1376975961
Provider Name (Legal Business Name): SHERRY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N UNION AVE
SHAWNEE OK
74801-7064
US

IV. Provider business mailing address

3807 N SHADYWOOD DR APT 426
MIDWEST CITY OK
73110-3540
US

V. Phone/Fax

Practice location:
  • Phone: 405-275-1844
  • Fax:
Mailing address:
  • Phone: 405-900-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: