Individual
BENJAMIN SCOTT ODOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC/APRN
Contact information
Practice address
538 BROADWAY, WINNIE, TX 77665-7600
(409) 296-6000
Mailing address
538 BROADWAY, WINNIE, TX 77665-7600
(318) 614-2241
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
63792
TX
363LF0000X
Family Nurse Practitioner
Primary
1098056
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1098056
TEXAS LICENSE APRN
TX
Enumeration date
07/30/2009
Last updated
01/19/2023
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