Healthcare Provider Details

I. General information

NPI: 1700110061
Provider Name (Legal Business Name): CASEY ODELL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 ZUNI ST
TAOS NM
87571-5202
US

IV. Provider business mailing address

713 ZUNI ST OFC
TAOS NM
87571-5202
US

V. Phone/Fax

Practice location:
  • Phone: 575-252-3028
  • Fax:
Mailing address:
  • Phone: 575-252-3028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCCMH0223691
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0013560
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number939
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: