Provider Demographics
NPI:1124891023
Name:ODOM, KATELYN MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:ODOM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1400 E OAKLAND PARK BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4400
Mailing Address - Country:US
Mailing Address - Phone:954-561-6222
Mailing Address - Fax:954-990-7650
Practice Address - Street 1:7200 CAMINO REAL STE 201
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5511
Practice Address - Country:US
Practice Address - Phone:561-674-0885
Practice Address - Fax:561-674-0856
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health