Provider Demographics
NPI:1144490798
Name:SMITH, MONTI JO
Entity type:Individual
Prefix:
First Name:MONTI
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E UNIVERSITY DR APT D7
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2027
Mailing Address - Country:US
Mailing Address - Phone:580-330-1566
Mailing Address - Fax:
Practice Address - Street 1:408 S 17TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-4236
Practice Address - Country:US
Practice Address - Phone:405-323-0312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health