Karen Odum
Individual provider Active NPI Mental Health Counselor · Du Quoin, IL
NPI 1376042663 · NPPES record last updated Feb 2, 2018
Key facts
- NPI
- 1376042663
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 1016 S Madison St
Du Quoin, IL 62832-2442 - Phone
- (618) 542-4357
- Fax
- (618) 542-3442
- NPI assigned
- Feb 2, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
1016 S Madison St
Du Quoin, IL 62832-2442
Mailing address
1016 S Madison St
Du Quoin, IL 62832-2442
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 376130900001 | Medicaid | IL |
NPI Registry JSON
{
"created_epoch": "1517529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517529600000",
"number": "1376042663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1016 S MADISON ST",
"city": "DU QUOIN",
"state": "IL",
"postal_code": "628322442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1016 S MADISON ST",
"city": "DU QUOIN",
"state": "IL",
"postal_code": "628322442",
"telephone_number": "618-542-4357",
"fax_number": "618-542-3442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODUM",
"first_name": "KAREN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-02",
"last_updated": "2018-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "376130900001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Du Quoin, IL
- Alan Gene Morris
- Christina Murphy
- Crystal Newcomb
- Timothy O'Boyle
- Darragh O'Connor
- Oneopto Il 1 PLLC
- Paige Otto
- Cynthia Palmer
- Richard C Parks
- Perry County Counseling Center
All providers in Du Quoin, IL · Mental Health Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.