MEDICARE: DR. SELEENA DAWN SMITH M.ED., PH.D

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	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1417341603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SELEENA DAWN SMITH M.ED., PH.D

Provider Business Mailing Address
First Line	:	512 W HILL ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7355
Country	:	US
Telephone Number	:	202-413-7051
Fax Number	:

Provider Business Practice Location Address
First Line	:	5929 N MAY AVE STE 302
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3925
Country	:	US
Telephone Number	:	405-842-0500
Fax Number	:	405-842-0505

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

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	03/25/2015

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