Provider Demographics
NPI:1871056887
Name:ODOM, SHELLY NEL (LCSW, M-RAS)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:NEL
Last Name:ODOM
Suffix:
Gender:
Credentials:LCSW, M-RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 SAN SABA CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-9702
Mailing Address - Country:US
Mailing Address - Phone:732-705-6716
Mailing Address - Fax:
Practice Address - Street 1:5405 SAN SABA CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-9702
Practice Address - Country:US
Practice Address - Phone:732-705-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2263671041C0700X
TX287001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical