Provider Demographics
NPI:1336412196
Name:ODUM, HEATHER WATT (LMHC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:WATT
Last Name:ODUM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:E
Other - Last Name:WATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-2815
Mailing Address - Country:US
Mailing Address - Phone:716-433-1937
Mailing Address - Fax:716-433-1961
Practice Address - Street 1:33 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-2815
Practice Address - Country:US
Practice Address - Phone:716-433-1937
Practice Address - Fax:716-433-1961
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005936-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health