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General NPI Number Information
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NPI Number | 1942547542
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Entity Type | Individual
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Provider Name | MR. CHARLES EDWARD SMILES I
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Gender | Male
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1011 HONOR HEIGHTS DRIVE
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City | MUSKOGEE
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State | OK
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Zip | 74401
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Country | US
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Telephone | 918-577-3000
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Fax | 918-628-1138
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Provider Business Mailing Address
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Address Line | 108 SW 8TH ST
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City | WAGONER
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State | OK
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Zip | 74467
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Country | US
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Telephone | 918-577-3000
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Fax | 918-628-1138
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OK
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