Provider Demographics
NPI:1093853061
Name:ODELL, THOMAS J (LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:ODELL
Suffix:
Gender:M
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 HILL RD N STE B
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9347
Mailing Address - Country:US
Mailing Address - Phone:614-833-6900
Mailing Address - Fax:614-833-6903
Practice Address - Street 1:647 HILL RD N STE B
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9347
Practice Address - Country:US
Practice Address - Phone:614-833-6900
Practice Address - Fax:614-833-6903
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH923172101YA0400X
OHI.00050961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)