Provider Demographics
NPI:1275150203
Name:ODYSSEY FOR PERSONAL WELLNESS INC.
Entity Type:Organization
Organization Name:ODYSSEY FOR PERSONAL WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:925-278-9045
Mailing Address - Street 1:1701 EPPING AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7859
Mailing Address - Country:US
Mailing Address - Phone:925-278-9045
Mailing Address - Fax:
Practice Address - Street 1:706 13TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2414
Practice Address - Country:US
Practice Address - Phone:925-278-9045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health