=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154582104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDY RENEE' SMITH LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2008
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5730 S MAY AVE
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73119-5604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-681-2221
-----------------------------------------------------
Fax | 405-681-2226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5235
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73070-5235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-292-7510
-----------------------------------------------------
Fax | 405-681-2226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 3304
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------