Provider Demographics
NPI:1154116432
Name:SMART, KATELYN ALICIA (LMSW)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ALICIA
Last Name:SMART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ALICIA
Other - Last Name:DECHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 N EIGHT TRIBES TRL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1011
Mailing Address - Country:US
Mailing Address - Phone:918-800-2965
Mailing Address - Fax:
Practice Address - Street 1:24 N EIGHT TRIBES TRL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1011
Practice Address - Country:US
Practice Address - Phone:918-800-2965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13816104100000X
OK21836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker