Provider Demographics
NPI:1578341640
Name:ODELL, FAITH L (SUDR)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:L
Last Name:ODELL
Suffix:
Gender:F
Credentials:SUDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8506
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-8506
Mailing Address - Country:US
Mailing Address - Phone:530-567-7766
Mailing Address - Fax:
Practice Address - Street 1:22425 SUNBRIGHT AVE
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-9741
Practice Address - Country:US
Practice Address - Phone:530-567-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1518660823101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)