Provider Demographics
NPI:1245787407
Name:O'DELL, LISA (MS, LMHC, LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:O'DELL
Suffix:
Gender:F
Credentials:MS, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NW LOVEJOY ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2863
Mailing Address - Country:US
Mailing Address - Phone:503-563-3420
Mailing Address - Fax:
Practice Address - Street 1:2525 NW LOVEJOY ST STE 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2863
Practice Address - Country:US
Practice Address - Phone:503-563-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health