Provider Demographics
NPI:1538890231
Name:O'DEL, JANINE ALICE (QMHP-R)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:ALICE
Last Name:O'DEL
Suffix:
Gender:F
Credentials:QMHP-R
Other - Prefix:MS
Other - First Name:JANINE
Other - Middle Name:ALICE
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, QMHP
Mailing Address - Street 1:348 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1710
Mailing Address - Country:US
Mailing Address - Phone:541-573-8376
Mailing Address - Fax:541-573-8378
Practice Address - Street 1:348 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1710
Practice Address - Country:US
Practice Address - Phone:541-573-8376
Practice Address - Fax:541-573-8378
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health