Provider Demographics
NPI:1184887200
Name:ODELL, DELORES H (LMFT)
Entity type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:H
Last Name:ODELL
Suffix:
Gender:F
Credentials:LMFT
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 128
Mailing Address - Street 2:
Mailing Address - City:LONE PINE
Mailing Address - State:CA
Mailing Address - Zip Code:93545-0128
Mailing Address - Country:US
Mailing Address - Phone:760-937-0937
Mailing Address - Fax:
Practice Address - Street 1:3420 SOUTH STATE HIGHWAY 395
Practice Address - Street 2:
Practice Address - City:LONE PINE
Practice Address - State:CA
Practice Address - Zip Code:93545-0128
Practice Address - Country:US
Practice Address - Phone:760-937-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT16512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health