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General NPI Number Information
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NPI Number | 1720384415
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Entity Type | Organization
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Legal Business Name | NEIL F. O'DONNELL, PHD, P.C.
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 2150 S AIRPORT RD W SUITEA
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4705
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Country | US
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Telephone | 231-929-9511
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Fax | 231-929-4790
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Provider Business Mailing Address
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Address Line | 2150 S AIRPORT RD W SUITEA
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4705
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Country | US
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Telephone | 231-929-9511
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Fax | 231-929-4790
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ANN CLARE O'DONNELL
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Credential | PSYD
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Telephone | 231-929-9511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301011799
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 6301011799
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301011534
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License Number State | MI
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