Provider Demographics
NPI:1104715077
Name:O'DELL, ELISSA ANN (TLMHC)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:ANN
Last Name:O'DELL
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-2142
Mailing Address - Country:US
Mailing Address - Phone:712-438-0021
Mailing Address - Fax:
Practice Address - Street 1:1905 10TH ST
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1630
Practice Address - Country:US
Practice Address - Phone:712-476-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA133025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health