Healthcare Provider Details

I. General information

NPI: 1609312602
Provider Name (Legal Business Name): JAZZ'LYNN SMITH LMSW U/S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S MADISON AVE
TULSA OK
74120-3208
US

IV. Provider business mailing address

2117 E 52ND ST
TULSA OK
74105-6417
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-1200
  • Fax:
Mailing address:
  • Phone: 918-382-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21895
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: