Provider Demographics
NPI:1134368764
Name:ODEN, KATHRYN A (PHD, LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:ODEN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3534
Mailing Address - Country:US
Mailing Address - Phone:940-453-3188
Mailing Address - Fax:866-246-1203
Practice Address - Street 1:1833 W HUNT ST STE 203
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3367
Practice Address - Country:US
Practice Address - Phone:940-453-3188
Practice Address - Fax:866-246-1203
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX617LLCOtherBLUE CROSS BLUE SHIELD