Provider Demographics
NPI:1710636386
Name:ODONNELL, LINDSAY (CSAC, CLC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:CSAC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 SW 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6991
Mailing Address - Country:US
Mailing Address - Phone:405-592-9417
Mailing Address - Fax:
Practice Address - Street 1:4666 W SAN SALVO DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5019
Practice Address - Country:US
Practice Address - Phone:405-592-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty