Provider Demographics
NPI:1285858399
Name:ODIACHI, CYRIL (MS, LPCI)
Entity Type:Individual
Prefix:
First Name:CYRIL
Middle Name:
Last Name:ODIACHI
Suffix:
Gender:M
Credentials:MS, LPCI
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:CYRIL
Other - Last Name:ODIACHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPCI
Mailing Address - Street 1:14802 ENTERPRISE DR
Mailing Address - Street 2:#46A
Mailing Address - City:FARMER BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234
Mailing Address - Country:US
Mailing Address - Phone:214-732-9904
Mailing Address - Fax:
Practice Address - Street 1:1353 N WESTMORELAND
Practice Address - Street 2:BUILDING A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211
Practice Address - Country:US
Practice Address - Phone:214-333-7015
Practice Address - Fax:214-333-4107
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health