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General NPI Number Information
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NPI Number | 1225845175
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Entity Type | Organization
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Legal Business Name | ODYSSEY BEHAVIORAL HEALTH CARE LLC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 4912 DUNCAN LN
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City | GASTONIA
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State | NC
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Zip | 28056-9361
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Country | US
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Telephone | 704-941-7938
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 39024
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City | CHARLOTTE
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State | NC
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Zip | 28278-1050
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Country | US
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Telephone | 704-941-7938
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAMLER REBECCA WALLS ERVIN
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Credential |
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Telephone | 704-941-7938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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