Provider Demographics
NPI:1891181210
Name:ODEM, JANIE
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:ODEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BEDIVERE DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1843
Mailing Address - Country:US
Mailing Address - Phone:361-564-6789
Mailing Address - Fax:
Practice Address - Street 1:3904 JOHN STOCKBAUER DR STE 111
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2456
Practice Address - Country:US
Practice Address - Phone:361-894-6830
Practice Address - Fax:855-427-6619
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69571101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health