Provider Demographics
NPI:1295066488
Name:CRAIG D. CHILDS, PHD, S.C.
Entity type:Organization
Organization Name:CRAIG D. CHILDS, PHD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-646-6404
Mailing Address - Street 1:385 WILLIAMSTOWNE, STE 301
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018
Mailing Address - Country:US
Mailing Address - Phone:262-646-6404
Mailing Address - Fax:262-646-6405
Practice Address - Street 1:385 WILLIAMSTOWNE, STE 301
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018
Practice Address - Country:US
Practice Address - Phone:262-646-6404
Practice Address - Fax:262-646-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2025-03-12
Deactivation Date:2013-06-12
Deactivation Code:
Reactivation Date:2025-03-11
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TC1900X, 103TF0000X, 103TC0700X
WI2834-057251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty