Provider Demographics
NPI:1790995231
Name:CHILDERS, ORRIN ODELL JR
Entity Type:Individual
Prefix:MR
First Name:ORRIN
Middle Name:ODELL
Last Name:CHILDERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10460 WEST HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:GREEN MOUNTAIN FALLS
Mailing Address - State:CO
Mailing Address - Zip Code:80819
Mailing Address - Country:US
Mailing Address - Phone:719-325-5265
Mailing Address - Fax:719-684-9743
Practice Address - Street 1:10460 W. HIGHWAY. 24
Practice Address - Street 2:
Practice Address - City:GREEN MOUNTAIN FALLS
Practice Address - State:CO
Practice Address - Zip Code:80819
Practice Address - Country:US
Practice Address - Phone:719-325-5265
Practice Address - Fax:719-684-9743
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO991077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health