Provider Demographics
NPI:1801339510
Name:ODEN, KATHRYN ELAINE (PHD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELAINE
Last Name:ODEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1322 PONDEROSA PINE LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1028
Mailing Address - Country:US
Mailing Address - Phone:214-274-0679
Mailing Address - Fax:469-617-7052
Practice Address - Street 1:3128 HUDSON XING STE 1
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6556
Practice Address - Country:US
Practice Address - Phone:469-252-7090
Practice Address - Fax:469-617-7052
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX26605103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical