Provider Demographics
NPI:1144506684
Name:SMITH, SYLVIA 'SHERRY' CHARISSE (MHR)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA 'SHERRY'
Middle Name:CHARISSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 HARDESTY DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1134
Mailing Address - Country:US
Mailing Address - Phone:405-395-9121
Mailing Address - Fax:
Practice Address - Street 1:499 HARDESTY DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1134
Practice Address - Country:US
Practice Address - Phone:405-395-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)