Provider Demographics
NPI:1972941029
Name:CHILDERS, DEBBIE R
Entity type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:R
Last Name:CHILDERS
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 1:101 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4421
Mailing Address - Country:US
Mailing Address - Phone:580-326-3382
Mailing Address - Fax:580-326-3383
Practice Address - Street 1:101 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4421
Practice Address - Country:US
Practice Address - Phone:580-326-3382
Practice Address - Fax:580-326-3383
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health