Provider Demographics
NPI:1851767099
Name:ODOM, LEMUEL (MED, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:LEMUEL
Middle Name:
Last Name:ODOM
Suffix:
Gender:M
Credentials:MED, LPC, LCDC
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 538
Mailing Address - Street 2:
Mailing Address - City:BACLIFF
Mailing Address - State:TX
Mailing Address - Zip Code:77518-0538
Mailing Address - Country:US
Mailing Address - Phone:832-561-2352
Mailing Address - Fax:
Practice Address - Street 1:1228 N LOGAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-5172
Practice Address - Country:US
Practice Address - Phone:832-561-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12590101YA0400X
TX71896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)