Provider Demographics
NPI:1477989846
Name:O'DELL, LINDA K (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:K
Last Name:O'DELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15404 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-2665
Mailing Address - Country:US
Mailing Address - Phone:661-619-7889
Mailing Address - Fax:310-579-8467
Practice Address - Street 1:100 WILSHIRE BLVD STE 700
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3602
Practice Address - Country:US
Practice Address - Phone:661-619-7889
Practice Address - Fax:310-579-8467
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB206636Medicare PIN
CACA151804Medicare PIN