MEDICARE: LESLIE G SMITH LADC-MH

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	971	OK
2	101YM0800X	Mental Health Counselor	971	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386887982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE G SMITH LADC-MH

Provider Business Mailing Address
First Line	:	1802 S CEDAR AVE
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-6409
Country	:	US
Telephone Number	:	918-984-8900
Fax Number	:	918-948-7927

Provider Business Practice Location Address
First Line	:	5272 S LEWIS AVE STE 126
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-6544
Country	:	US
Telephone Number	:	918-984-8900
Fax Number	:	918-948-7927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	05/19/2026

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Directions to “ LESLIE G SMITH LADC-MH” Practice Location

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