MEDICARE: CHRISTINE ODELL MS LPCC JSOC

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	101YM0800X	Mental Health Counselor	E. 0800154	OH

General Provider Information

NPI Number	:	1548624133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ODELL MS LPCC JSOC

Provider Business Mailing Address
First Line	:	515 WINDSOR PARK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4112
Country	:	US
Telephone Number	:	937-723-9881
Fax Number	:	937-723-9888

Provider Business Practice Location Address
First Line	:	515 WINDSOR PARK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4112
Country	:	US
Telephone Number	:	937-723-9881
Fax Number	:	937-723-9888

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

Provider Enumeration Date	:	04/08/2016
Last Update Date	:	08/05/2024

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