Individual
KELLEN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
312 NE 28TH ST, OKLAHOMA CITY, OK 73105-2804
(405) 231-3150
Mailing address
8813 NE 12TH ST, MIDWEST CITY, OK 73110-7113
(405) 301-6521
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/03/2010
Last updated
11/03/2010
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