=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477989846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA K O'DELL PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2013
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 WILSHIRE BLVD STE 700
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90401-3602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-619-7889
-----------------------------------------------------
Fax | 310-579-8467
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15404 RUSSELL RD
-----------------------------------------------------
City | CHAGRIN FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44022-2665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-619-7889
-----------------------------------------------------
Fax | 310-579-8467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY25831
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------