Provider Demographics
NPI:1477745974
Name:ODOM, RITA S
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:S
Last Name:ODOM
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 1:425 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-2810
Mailing Address - Country:US
Mailing Address - Phone:405-230-1416
Mailing Address - Fax:405-552-2621
Practice Address - Street 1:425 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-2810
Practice Address - Country:US
Practice Address - Phone:405-230-1416
Practice Address - Fax:405-552-2621
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)