Healthcare Provider Details

I. General information

NPI: 1386548220
Provider Name (Legal Business Name): HALLIE ODEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 77TH ST
LUBBOCK TX
79423-1812
US

IV. Provider business mailing address

3312 77TH ST
LUBBOCK TX
79423-1812
US

V. Phone/Fax

Practice location:
  • Phone: 806-939-2811
  • Fax:
Mailing address:
  • Phone: 806-939-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number104286
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: