Provider Demographics
NPI:1992971956
Name:CHILDS, TONI LOUISE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:LOUISE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 SHASTA DAM BLVD SPC 110
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9592
Mailing Address - Country:US
Mailing Address - Phone:530-524-7246
Mailing Address - Fax:
Practice Address - Street 1:2750 EUREKA WAY STE 101
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0251
Practice Address - Country:US
Practice Address - Phone:530-524-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45610106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist