Individual
IAN MICHAEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
712 DEVON ST, STILLWATER, OK 74074-1926
(405) 372-6100
Mailing address
1442 E OAK ST, CUSHING, OK 74023-3644
(580) 670-4511
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
10038
OK
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
04/18/2013
Last updated
03/21/2022
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