Provider Demographics
NPI:1740469626
Name:ODOM, SHARON RENEE (MS MFT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:RENEE
Last Name:ODOM
Suffix:
Gender:F
Credentials:MS MFT
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 578601
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-8601
Mailing Address - Country:US
Mailing Address - Phone:209-450-6245
Mailing Address - Fax:209-579-5710
Practice Address - Street 1:2125 WYLIE DR STE 9
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3847
Practice Address - Country:US
Practice Address - Phone:209-450-4265
Practice Address - Fax:209-579-5710
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health