Provider Demographics
NPI:1689722373
Name:ODIAM, RICHARD J (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:ODIAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5827 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9233 WARD PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3366
Practice Address - Country:US
Practice Address - Phone:913-327-4686
Practice Address - Fax:816-333-1776
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0050561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495456105Medicaid
MOD76B461Medicare PIN