Provider Demographics
NPI:1033908488
Name:KIMBERLY D CHILDERS LSCSW LLC
Entity type:Organization
Organization Name:KIMBERLY D CHILDERS LSCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-469-1106
Mailing Address - Street 1:7570 W 21ST ST N STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-469-1106
Mailing Address - Fax:833-392-1160
Practice Address - Street 1:7570 W 21ST ST N STE A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-469-1106
Practice Address - Fax:833-392-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty