Healthcare Provider Details

I. General information

NPI: 1316431307
Provider Name (Legal Business Name): CHRISTINE ANN CHILDS BEHAVIORAL SPECIALIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 THOMPSON DR
SEDRO WOOLLEY WA
98284-5007
US

IV. Provider business mailing address

1351 ORCHARD LOOP
OAK HARBOR WA
98277-8905
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-3186
  • Fax:
Mailing address:
  • Phone: 360-708-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: