Provider Demographics
NPI:1871944603
Name:ODOM, TINA (IMF)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:ODOM
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7070 SCHIRRA CT STE 200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-2122
Mailing Address - Country:US
Mailing Address - Phone:661-834-7564
Mailing Address - Fax:661-831-8882
Practice Address - Street 1:7070 SCHIRRA CT STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2122
Practice Address - Country:US
Practice Address - Phone:661-834-7564
Practice Address - Fax:661-831-8882
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist