Healthcare Provider Details

I. General information

NPI: 1053851782
Provider Name (Legal Business Name): BETH O'DELL LCPC, LCMHC, MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 FARMGATE RD
SOUTH BERWICK ME
03908-1825
US

IV. Provider business mailing address

22 FARMGATE RD
SOUTH BERWICK ME
03908-1825
US

V. Phone/Fax

Practice location:
  • Phone: 207-436-4026
  • Fax: 207-331-8804
Mailing address:
  • Phone: 207-436-4026
  • Fax: 207-331-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1212
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC6570
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2118
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: