Provider Demographics
NPI:1790715514
Name:WAUGH, ODALYS J (LMHC)
Entity Type:Individual
Prefix:
First Name:ODALYS
Middle Name:J
Last Name:WAUGH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SW 137TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1435
Mailing Address - Country:US
Mailing Address - Phone:305-671-3503
Mailing Address - Fax:305-671-3505
Practice Address - Street 1:9000 SW 137TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1435
Practice Address - Country:US
Practice Address - Phone:305-671-3503
Practice Address - Fax:305-671-3505
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH8795OtherLIC MENTAL HEALTH COUNS