Provider Demographics
NPI:1154582104
Name:SMITH, BRANDY RENEE' (LCSW)
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:RENEE'
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5235
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5235
Mailing Address - Country:US
Mailing Address - Phone:405-292-7510
Mailing Address - Fax:405-681-2226
Practice Address - Street 1:5730 S MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-5604
Practice Address - Country:US
Practice Address - Phone:405-681-2221
Practice Address - Fax:405-681-2226
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical