Provider Demographics
NPI:1972993103
Name:ODOM, CIARA JEAN (LPC, LAC, NCC, ACS)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:JEAN
Last Name:ODOM
Suffix:
Gender:
Credentials:LPC, LAC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26032
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80497-6032
Mailing Address - Country:US
Mailing Address - Phone:208-339-8398
Mailing Address - Fax:
Practice Address - Street 1:124 MAIN ST.
Practice Address - Street 2:SUITE #305
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435
Practice Address - Country:US
Practice Address - Phone:208-339-8398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016112101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health