Basic Information
| Provider Information | |||||||||
| NPI: | 1417074659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ODEGARD | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD, LMFT, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17558 CROSS RD | ||||||||
| Address2: | |||||||||
| City: | PRUNEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939071571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316636669 | ||||||||
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| Practice Location | |||||||||
| Address1: | 604 PEARL ST | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939403070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316494522 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT78630 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | LPCC1160 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.