Active NPI
Lisa Ellen Odegaard, MA, MFT
- Mental Health Counselor
- Medford, OR
National Provider Identifier
1720382229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MFC # 30449
- Practice address
- 140 South Holly Street
Medford, OR 97501 - Phone
- (541) 774-8200
- Fax
- (541) 774-7964
- NPI assigned
- Dec 27, 2010
- Last updated
- Dec 11, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MFC # 30449 | CA | Primary |
Addresses
Primary practice location
140 South Holly Street
Medford, OR 97501
Mailing address
140 South Holly Street
Medford, OR 97501
Phone (541) 774-8200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC # 30449 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418256000000",
"number": "1720382229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 SOUTH HOLLY STREET",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97501",
"telephone_number": "541-774-8200",
"fax_number": "541-774-7964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 SOUTH HOLLY STREET",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97501",
"telephone_number": "541-774-8200",
"fax_number": "541-774-7964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODEGAARD",
"first_name": "LISA",
"middle_name": "ELLEN",
"credential": "MA, MFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-27",
"last_updated": "2014-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "MFC # 30449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.