MEDICARE: DR. WOODY CAL CHILDRESS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2-3301	TX
2	103TS0200X	School Psychologist	6637	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013064534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WOODY CAL CHILDRESS PH.D.

Provider Business Mailing Address
First Line	:	1400 ADEN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1959
Country	:	US
Telephone Number	:	817-731-2468
Fax Number	:

Provider Business Practice Location Address
First Line	:	5658 WESTCREEK DR STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-2254
Country	:	US
Telephone Number	:	817-731-2468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	09/11/2025

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Directions to “ DR. WOODY CAL CHILDRESS PH.D.” Practice Location

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