MEDICARE: ERIC ODELL

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1467263541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC ODELL

Provider Business Mailing Address
First Line	:	3616 10TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-4113
Country	:	US
Telephone Number	:	480-336-0815
Fax Number	:

Provider Business Practice Location Address
First Line	:	3616 10TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-4113
Country	:	US
Telephone Number	:	480-336-0815
Fax Number	:

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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Directions to “ ERIC ODELL ” Practice Location

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