MEDICARE: KATHRYN A ODEN PHD, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	12397	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	617LLC	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134368764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN A ODEN PHD, LPC

Provider Business Mailing Address
First Line	:	206 NORTHWOOD DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-3534
Country	:	US
Telephone Number	:	940-453-3188
Fax Number	:	866-246-1203

Provider Business Practice Location Address
First Line	:	1833 W HUNT ST STE 203
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-3367
Country	:	US
Telephone Number	:	940-453-3188
Fax Number	:	866-246-1203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	02/23/2022

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