Healthcare Provider Details

I. General information

NPI: 1164472403
Provider Name (Legal Business Name): BRENDA LEE SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 E 51ST ST SUITE #400
TULSA OK
74135-7461
US

IV. Provider business mailing address

6211 S YORKTOWN AVE
TULSA OK
74136-0904
US

V. Phone/Fax

Practice location:
  • Phone: 918-388-6248
  • Fax: 918-388-6456
Mailing address:
  • Phone: 918-814-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1931
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: