Provider Demographics
NPI:1578050076
Name:CHILDERS-SCOTT, THOMAS J (LMSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:CHILDERS-SCOTT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 W HUNTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-7125
Mailing Address - Country:US
Mailing Address - Phone:208-850-8410
Mailing Address - Fax:
Practice Address - Street 1:7941 W RIFLEMAN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9001
Practice Address - Country:US
Practice Address - Phone:208-895-7950
Practice Address - Fax:208-322-0048
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-350831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical