MEDICARE: KAREN R O'DEA 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	101YP2500X	Professional Counselor	2007000804	MO

General Provider Information

NPI Number	:	1710277900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN R O'DEA LPC

Provider Business Mailing Address
First Line	:	2809 NE 39TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64117-2101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2370 KERNER BLVD
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-5546
Country	:	US
Telephone Number	:	800-327-2133
Fax Number	:

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

Provider Enumeration Date	:	04/09/2011
Last Update Date	:	01/20/2017

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