Provider Demographics
NPI:1114174927
Name:O'DELL, KATHLEEN RUTH (MA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RUTH
Last Name:O'DELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:RR 3 BOX 1700
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263-9670
Practice Address - Country:US
Practice Address - Phone:276-346-3590
Practice Address - Fax:276-346-3612
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor