Individual
CORLISEA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
820 W 15TH ST, EDMOND, OK 73013-3621
(570) 240-7271
Mailing address
820 W 15TH ST, EDMOND, OK 73013-3621
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/22/2025
Last updated
07/27/2025
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