MEDICARE: W ERIC ODOM LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2144	LA

General Provider Information

NPI Number	:	1316254923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	W ERIC ODOM LPC

Provider Business Mailing Address
First Line	:	4836 WABASH ST
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-6717
Country	:	US
Telephone Number	:	504-780-2766
Fax Number	:	504-779-8297

Provider Business Practice Location Address
First Line	:	4836 WABASH ST
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-6717
Country	:	US
Telephone Number	:	504-780-2766
Fax Number	:	504-779-8297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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