Provider Demographics
NPI:1619588506
Name:ODOM, JEAN MARIE (LPC, NCC, CSC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:ODOM
Suffix:
Gender:F
Credentials:LPC, NCC, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29527 FULSHEAR LAKE TRCE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3313
Mailing Address - Country:US
Mailing Address - Phone:210-213-7857
Mailing Address - Fax:
Practice Address - Street 1:29527 FULSHEAR LAKE TRCE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-3313
Practice Address - Country:US
Practice Address - Phone:210-213-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health