Provider Demographics
NPI:1134155088
Name:CHILDERS, MICHAEL HENRY (LMHC, CMHS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HENRY
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:LMHC, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8435
Mailing Address - Country:US
Mailing Address - Phone:425-822-5519
Mailing Address - Fax:
Practice Address - Street 1:1022 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2018
Practice Address - Country:US
Practice Address - Phone:425-349-8810
Practice Address - Fax:425-349-8815
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health