Healthcare Provider Details

I. General information

NPI: 1720116460
Provider Name (Legal Business Name): DESIREE ODOM MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 GRIFFIN AVE
LOS ANGELES CA
90031-3312
US

IV. Provider business mailing address

1145 BRIANNA AVE
LANCASTER CA
93535-2931
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-4134
  • Fax:
Mailing address:
  • Phone: 323-401-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: