Healthcare Provider Details

I. General information

NPI: 1275351629
Provider Name (Legal Business Name): SIERRA JADE CHILDERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HILLCREST DR
WACO TX
76708-3157
US

IV. Provider business mailing address

3500 HILLCREST DR
WACO TX
76708-3157
US

V. Phone/Fax

Practice location:
  • Phone: 254-262-3506
  • Fax:
Mailing address:
  • Phone: 254-262-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number89496
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: