Provider Demographics
NPI:1194008920
Name:SMITHSON, KIM MARI (CADC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARI
Last Name:SMITHSON
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-6029
Mailing Address - Country:US
Mailing Address - Phone:405-464-1217
Mailing Address - Fax:
Practice Address - Street 1:1217 W INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6029
Practice Address - Country:US
Practice Address - Phone:405-464-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK169101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)