Provider Demographics
NPI:1568807865
Name:CHILDS, ALEXANDRIA (LPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1790
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638
Mailing Address - Country:US
Mailing Address - Phone:208-866-1261
Mailing Address - Fax:
Practice Address - Street 1:409 S 3RD ST
Practice Address - Street 2:A
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5000
Practice Address - Country:US
Practice Address - Phone:208-634-2962
Practice Address - Fax:208-634-5064
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health