Healthcare Provider Details

I. General information

NPI: 1003357906
Provider Name (Legal Business Name): REBEKA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 N 94TH EAST AVE
TULSA OK
74115-5919
US

IV. Provider business mailing address

3445 S SHERIDAN RD
TULSA OK
74145-1105
US

V. Phone/Fax

Practice location:
  • Phone: 918-852-9098
  • Fax:
Mailing address:
  • Phone: 918-610-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number313176
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: