Healthcare Provider Details

I. General information

NPI: 1366364093
Provider Name (Legal Business Name): MELANNIE KATHERINE LAYA ODALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANNIE KATHERINE LAYA

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26650 WESLEY CHAPEL BLVD
LUTZ FL
33559-7203
US

IV. Provider business mailing address

26650 WESLEY CHAPEL BLVD
LUTZ FL
33559-7203
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-4230
  • Fax:
Mailing address:
  • Phone: 813-948-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: