Individual
MARIAH ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2620 CENTENARY BLVD UNIT 3, SHREVEPORT, LA 71104-3356
(903) 330-7064
Mailing address
2620 CENTENARY BLVD UNIT 3, SHREVEPORT, LA 71104-3356
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
8872
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
09/01/2021
Last updated
07/16/2024
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