Provider Demographics
NPI:1295228344
Name:JULIE ODONNELL PHD LLC
Entity Type:Organization
Organization Name:JULIE ODONNELL PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ODONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:785-288-8172
Mailing Address - Street 1:PO BOX 8575
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64508-8575
Mailing Address - Country:US
Mailing Address - Phone:816-248-8929
Mailing Address - Fax:816-873-1220
Practice Address - Street 1:708 S WOODBINE RD STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507
Practice Address - Country:US
Practice Address - Phone:816-248-8929
Practice Address - Fax:816-873-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018012574261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)