Individual
KYLE BRENT ODESHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 BEATTY ST, MEDFORD, OR 97501-5811
(541) 476-2373
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
CA
Other
Enumeration date
08/29/2020
Last updated
12/29/2023
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