Provider Demographics
NPI:1942546668
Name:ODDEN, JOHN (REVEREND)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:ODDEN
Suffix:
Gender:M
Credentials:REVEREND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 COLONY PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6343
Mailing Address - Country:US
Mailing Address - Phone:949-891-2151
Mailing Address - Fax:949-713-5501
Practice Address - Street 1:4223 COLONY PLZ
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6343
Practice Address - Country:US
Practice Address - Phone:949-891-2151
Practice Address - Fax:949-713-5501
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral