Provider Demographics
NPI:1265699441
Name:KIRSTIN ODOU, DIANE (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:KIRSTIN ODOU
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41700 IVY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:951-326-4223
Mailing Address - Fax:951-695-7316
Practice Address - Street 1:41700 IVY ST
Practice Address - Street 2:SUITE B
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-326-4223
Practice Address - Fax:951-695-7316
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist