Provider Demographics
NPI:1407101272
Name:O'DONNELL, JANET R
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:R
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LARSON LN STE 200
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-4593
Mailing Address - Country:US
Mailing Address - Phone:817-668-5056
Mailing Address - Fax:
Practice Address - Street 1:107 LARSON LN STE 202
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-4590
Practice Address - Country:US
Practice Address - Phone:817-668-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60252235101YM0800X
WAPY60311615103T00000X
TX38958103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health