Provider Demographics
NPI:1487890539
Name:CHILDERS, JAMES MARSHALL (LCPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MARSHALL
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 S PICHER AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1645
Mailing Address - Country:US
Mailing Address - Phone:417-347-7700
Mailing Address - Fax:
Practice Address - Street 1:810 CEDAR ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:KS
Practice Address - Zip Code:66743-2056
Practice Address - Country:US
Practice Address - Phone:620-724-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03002101YP2500X
OK6791101YP2500X
MO2007034754101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional