Provider Demographics
NPI:1427797927
Name:GILES SMITHERMAN, JA'LEESA T (MCMHC, LPC CANDIDATE)
Entity type:Individual
Prefix:MRS
First Name:JA'LEESA
Middle Name:T
Last Name:GILES SMITHERMAN
Suffix:
Gender:F
Credentials:MCMHC, LPC CANDIDATE
Other - Prefix:MRS
Other - First Name:JALEESA
Other - Middle Name:
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MCMHC, LPC CANDIDATE
Mailing Address - Street 1:2501 PENDLETON DR APT 1814
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3469
Mailing Address - Country:US
Mailing Address - Phone:682-208-5002
Mailing Address - Fax:
Practice Address - Street 1:620 NW 5TH ST STE D
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3947
Practice Address - Country:US
Practice Address - Phone:405-208-4469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
OKLPCCANDIDATE12557101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician