Provider Demographics
NPI:1629243217
Name:ODELL, COLLEEN C (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:C
Last Name:ODELL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 SW YAMHILL ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2545
Mailing Address - Country:US
Mailing Address - Phone:503-545-6312
Mailing Address - Fax:503-575-9162
Practice Address - Street 1:1033 SW YAMHILL ST
Practice Address - Street 2:SUITE 401
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2545
Practice Address - Country:US
Practice Address - Phone:503-545-6312
Practice Address - Fax:503-575-9162
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2159101YM0800X, 101YA0400X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor