Provider Demographics
NPI:1437491701
Name:CHILDERS, CHRISTOPHER SHAWN (MSC, LPCC-S)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHAWN
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:MSC, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 JAMES WAY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5892
Mailing Address - Country:US
Mailing Address - Phone:419-617-8356
Mailing Address - Fax:
Practice Address - Street 1:147 JAMES WAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5892
Practice Address - Country:US
Practice Address - Phone:419-617-8356
Practice Address - Fax:740-914-6138
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005957101YP2500X
OHC1300110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional