Provider Demographics
NPI:1891284741
Name:O'DELL, ROBIN LYNN (AMFT/SUD-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:O'DELL
Suffix:
Gender:F
Credentials:AMFT/SUD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12608 S 125 W STE E
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8437
Mailing Address - Country:US
Mailing Address - Phone:801-810-1119
Mailing Address - Fax:801-203-9216
Practice Address - Street 1:12608 S 125 W STE E
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8437
Practice Address - Country:US
Practice Address - Phone:801-810-1119
Practice Address - Fax:801-203-9216
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8585303-3904106H00000X
UT8585303-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist