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General NPI Number Information
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NPI Number | 1336478395
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Entity Type | Organization
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Legal Business Name | RAEGAN SMITH PSYCHOLOGICAL SERVICES LTD, PC
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 3750 W MAIN ST
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City | NORMAN
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State | OK
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Zip | 73072-4657
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Country | US
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Telephone | 405-801-2835
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 W MAIN ST
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City | NORMAN
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State | OK
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Zip | 73072-4657
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Country | US
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Telephone | 405-801-2835
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/CEO
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Name | DR. RAEGAN B SMITH
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Credential | PH.D.
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Telephone | 405-801-2835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1043
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License Number State | OK
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