Doctor Name: | MELISSA ODEGARD |
NPI Number: | 1710197942 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 500 S 11th Ave Suite 302 Pocatello, ID - 832014835 |
Business Phone Number: | 2082330150 |
Business Fax Number: | |
Mailing Address: | 455 N 16th Ave, POCATELLO |
State: | ID |
Postal Code: | 832014053 |
Phone Number: | 2082361600 |
Fax Number: | |
NPI Enumeration Date: | 05/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |