Provider Demographics
NPI:1518970185
Name:ODELL, JOHN R (LIMHP LMHP LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:ODELL
Suffix:
Gender:M
Credentials:LIMHP LMHP LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 O ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2647
Mailing Address - Country:US
Mailing Address - Phone:402-617-9143
Mailing Address - Fax:888-959-0716
Practice Address - Street 1:8101 O ST STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2647
Practice Address - Country:US
Practice Address - Phone:402-617-9143
Practice Address - Fax:888-959-0716
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2907101Y00000X
NE250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025069900Medicaid
714014000OtherMAGELLAN
NE85435OtherBLUE CROSS