Provider Demographics
NPI:1104132141
Name:SMILEY, RACHEL BETH KIRKPATRICK (T-LMLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:BETH KIRKPATRICK
Last Name:SMILEY
Suffix:
Gender:F
Credentials:T-LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 SE 49TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-2707
Mailing Address - Country:US
Mailing Address - Phone:405-833-6108
Mailing Address - Fax:
Practice Address - Street 1:604 S CLASSEN AVE
Practice Address - Street 2:STE. A
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5401
Practice Address - Country:US
Practice Address - Phone:405-735-6333
Practice Address - Fax:405-735-6629
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1361103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling