Healthcare Provider Details

I. General information

NPI: 1073548749
Provider Name (Legal Business Name): MRS. TERRY J O'DELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TJ O'DELL M.A.

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S COWLEY ST
SPOKANE WA
99202-1330
US

IV. Provider business mailing address

711 S COWLEY ST
SPOKANE WA
99202-1330
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-6866
  • Fax: 509-473-6780
Mailing address:
  • Phone: 509-473-6866
  • Fax: 509-473-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005702
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: