Provider Demographics
NPI:1811134109
Name:ODLE, LEA VALERIE (LISW, LMSW, SAP)
Entity type:Individual
Prefix:MS
First Name:LEA
Middle Name:VALERIE
Last Name:ODLE
Suffix:
Gender:F
Credentials:LISW, LMSW, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SAXON RD
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-9496
Mailing Address - Country:US
Mailing Address - Phone:505-203-3568
Mailing Address - Fax:
Practice Address - Street 1:600 1ST ST NW STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2311
Practice Address - Country:US
Practice Address - Phone:505-224-9124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-06255104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker