Provider Demographics
NPI:1578350880
Name:ODEN, BEVERLY (LPCC)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:ODEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27068 LA PAZ RD # 712
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3041
Mailing Address - Country:US
Mailing Address - Phone:949-424-3473
Mailing Address - Fax:
Practice Address - Street 1:19712 MACARTHUR BLVD STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2407
Practice Address - Country:US
Practice Address - Phone:949-424-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty