Provider Demographics
NPI:1720032113
Name:CHILDERS, CHRISTINE J (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CONWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3112
Mailing Address - Country:US
Mailing Address - Phone:406-751-5664
Mailing Address - Fax:406-755-0971
Practice Address - Street 1:7325 US HIGHWAY 93
Practice Address - Street 2:SUITE A
Practice Address - City:LAKESIDE
Practice Address - State:MT
Practice Address - Zip Code:59922-9704
Practice Address - Country:US
Practice Address - Phone:406-844-2890
Practice Address - Fax:406-844-2891
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT327103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT52341OtherBLUE CROSS
MT492575Medicaid