Provider Demographics
NPI:1497011514
Name:ODELL, LAUREN LEIGH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:LEIGH
Last Name:ODELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 W MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-4823
Mailing Address - Country:US
Mailing Address - Phone:772-468-5600
Mailing Address - Fax:
Practice Address - Street 1:2806 S US HIGHWAY 1
Practice Address - Street 2:SUITE C-7
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8109
Practice Address - Country:US
Practice Address - Phone:772-467-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2655106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist