Provider Demographics
NPI:1558849943
Name:ODELL, MARK (LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ODELL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5578 SHADOW GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-1051
Mailing Address - Country:US
Mailing Address - Phone:850-377-1354
Mailing Address - Fax:
Practice Address - Street 1:6425 PENSACOLA BLVD STE 1-3
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-1701
Practice Address - Country:US
Practice Address - Phone:850-471-0017
Practice Address - Fax:850-471-0009
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health