Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 313176 | OK |
NPI | 1003357906 |
---|---|
Provider Name | Rebeka Smith |
First Address | Tulsa, OK 74145-1105 |
Second Address | Tulsa, OK 74115-5919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2017 |
Last Update Date | 15/07/2020 |