Provider Demographics
NPI:1063894376
Name:CHILDRESS, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12978
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2978
Mailing Address - Country:US
Mailing Address - Phone:405-858-2700
Mailing Address - Fax:405-858-2810
Practice Address - Street 1:2403 S DIVISION ST
Practice Address - Street 2:SUITE C & D
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6027
Practice Address - Country:US
Practice Address - Phone:405-260-3441
Practice Address - Fax:405-260-3442
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK1240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor