Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1316190655 |
---|---|
Provider Name | Lance Obrian Smith |
First Address | Oklahoma City, OK 73120-5063 |
Second Address | Oklahoma City, OK 73120-5063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2008 |
Last Update Date | 20/02/2014 |