Provider Demographics
NPI:1154330405
Name:O'DEA, JOHN NOEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:NOEL
Last Name:O'DEA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 PRUDENTIAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-4109
Mailing Address - Country:US
Mailing Address - Phone:214-522-4640
Mailing Address - Fax:214-522-4650
Practice Address - Street 1:1475 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-4109
Practice Address - Country:US
Practice Address - Phone:214-522-4640
Practice Address - Fax:214-522-4650
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14647101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor