ODOM RICHARD - NPI: 1689216483


Mood disorder is a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature. The classification is known as mood (affective) disorders in International Classification of Diseases (ICD).

NPI: 1689216483
Entity Type: Person: individual human being who furnishes health care.
Provider First Name: RICHARD
Provider Last Name: ODOM
Provider Gender Code: M
Provider Enumeration Date: 10/13/2019
Last Update Date: 10/13/2019

Business Address:

Provider First Line Business Mailing Address: 213 E 2ND ST
Provider Business Mailing Address City Name: FAIRMONT
Provider Business Mailing Address State Name: MN
Provider Business Mailing Address Postal Code: 56031
Provider Business Mailing Address Country Code (If outside U.S.): US
Phone: 5072361889

Mailing Address:

Provider First Line Business Practice Location Address: 213 E 2ND ST
Provider Business Practice Location Address City Name: FAIRMONT
Provider Business Practice Location Address State Name: MN
Provider Business Practice Location Address Postal Code: 56031
Provider Business Practice Location Address Country Code (If outside U.S.): US
Phone: 5072361889

Primary Taxonomy:

Taxonomy Code: 101YA0400X
License Number: 302138
License State: MN
Healthcare Provider Primary Taxonomy Switch: N - The taxonomy is not the primary taxonomy
Type: Behavioral Health & Social Service Providers
Classification: Counselor
Specialization: Addiction (Substance Use Disorder)
Definition: Definition to come...

Secondary Taxonomy:

Taxonomy Code: 101YM0800X
License Number: 2346
License State: MN
Healthcare Provider Primary Taxonomy Switch: Y - The taxonomy is the primary taxonomy (there can be only one per NPI record
Type: Behavioral Health & Social Service Providers
Classification: Counselor
Specialization: Mental Health
Definition: Definition to come...
Source: The National Provider Identifier

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