Provider Demographics
NPI:1912347055
Name:KODAD, MOLLY LYNN (MS, PPS)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:LYNN
Last Name:KODAD
Suffix:
Gender:F
Credentials:MS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5999
Mailing Address - Country:US
Mailing Address - Phone:530-891-3026
Mailing Address - Fax:530-891-3220
Practice Address - Street 1:1163 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5999
Practice Address - Country:US
Practice Address - Phone:530-891-3026
Practice Address - Fax:530-891-3220
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240067951101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool