Individual
MR. ANDREW TYLER ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
9196 W EMERALD ST STE 135, BOISE, ID 83704-8004
(208) 323-4400
Mailing address
9196 W EMERALD ST STE 135, BOISE, ID 83704-8004
(208) 323-4400
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
06/12/2013
Last updated
12/15/2014
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