Healthcare Provider Details

I. General information

NPI: 1952634974
Provider Name (Legal Business Name): CHRISTY KAY ODEN L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 50TH ST
LUBBOCK TX
79414-3521
US

IV. Provider business mailing address

PO BOX 54352
LUBBOCK TX
79453-4352
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-8808
  • Fax: 806-771-8809
Mailing address:
  • Phone: 806-441-7002
  • Fax: 806-771-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: