Provider Demographics
NPI:1932677887
Name:O'DELL, WYATT (LMHC)
Entity Type:Individual
Prefix:
First Name:WYATT
Middle Name:
Last Name:O'DELL
Suffix:
Gender:M
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:PO BOX 3183
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3183
Mailing Address - Country:US
Mailing Address - Phone:509-744-1117
Mailing Address - Fax:509-744-3055
Practice Address - Street 1:1106 N WASHINGTON ST STE D
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2205
Practice Address - Country:US
Practice Address - Phone:509-744-1117
Practice Address - Fax:509-744-3055
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60905406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health