Basic Information
| Provider Information | |||||||||
| NPI: | 1104132141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMILEY | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | BETH KIRKPATRICK | ||||||||
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| Credential: | T-LMLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 SE 49TH TER | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731352707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058336108 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 604 S CLASSEN AVE | ||||||||
| Address2: | STE. A | ||||||||
| City: | MOORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731605401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057356333 | ||||||||
| FaxNumber: | 4057356629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2010 | ||||||||
| LastUpdateDate: | 07/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 1361 | KS | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.