Provider Demographics
NPI:1871056887
Name:ODOM, SHELLY NEL (LCSW, M-RAS)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:NEL
Last Name:ODOM
Suffix:
Gender:F
Credentials:LCSW, M-RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2504
Mailing Address - Country:US
Mailing Address - Phone:513-984-1800
Mailing Address - Fax:513-984-4909
Practice Address - Street 1:86TH MEDICAL GROUP
Practice Address - Street 2:UNIT 3215
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09094-3215
Practice Address - Country:US
Practice Address - Phone:637-146-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical