Healthcare Provider Details

I. General information

NPI: 1861640484
Provider Name (Legal Business Name): ELIZABETH CLAIRE CHILDRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 RIO LINDO AVE
CHICO CA
95926-1817
US

IV. Provider business mailing address

1418 ALMOND ST
CHICO CA
95928-6412
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2775
  • Fax:
Mailing address:
  • Phone: 650-269-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: