Basic Information
| Provider Information | |||||||||
| NPI: | 1013114941 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., L.P.C. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1728 S CARSON AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741194610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188161149 | ||||||||
| FaxNumber: | 9182800310 | ||||||||
| Practice Location | |||||||||
| Address1: | 1728 S CARSON AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741194610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188161149 | ||||||||
| FaxNumber: | 9182800310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 5282 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | MS LPC UNDER SUP. | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.