Provider Demographics
NPI:1487944260
Name:SMOOT, TONDA (LPC)
Entity type:Individual
Prefix:
First Name:TONDA
Middle Name:
Last Name:SMOOT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5772
Mailing Address - Country:US
Mailing Address - Phone:405-285-2080
Mailing Address - Fax:405-285-2565
Practice Address - Street 1:1320 E 9TH ST
Practice Address - Street 2:STE. 8
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5772
Practice Address - Country:US
Practice Address - Phone:405-285-2080
Practice Address - Fax:405-285-2565
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional