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NPI Code Detail

MEDICARE: MS. KELLY JEAN SMITH-TROUTMAN LPC

MEDICARE:  MS. KELLY JEAN SMITH-TROUTMAN  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor4513OK

General Provider Information

NPI Number : 1336260751
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY JEAN SMITH-TROUTMAN LPC
Provider Business Mailing Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 844-458-2100
Fax Number :
Provider Business Practice Location Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 844-458-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 08/25/2023

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