Provider Demographics
NPI:1942897319
Name:ODELL, HOLLY K
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:K
Last Name:ODELL
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:PO BOX 7834
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-0834
Mailing Address - Country:US
Mailing Address - Phone:406-212-7254
Mailing Address - Fax:
Practice Address - Street 1:2 1ST ST E STE 1
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4553
Practice Address - Country:US
Practice Address - Phone:406-212-7254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health