Provider Demographics
NPI:1144935982
Name:CHILDRESS, ANTHONY JEROME (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JEROME
Last Name:CHILDRESS
Suffix:
Gender:M
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 WOODWAY DR STE 306W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1828
Mailing Address - Country:US
Mailing Address - Phone:832-332-3703
Mailing Address - Fax:713-583-1504
Practice Address - Street 1:4801 WOODWAY DR STE 306W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1828
Practice Address - Country:US
Practice Address - Phone:832-925-8967
Practice Address - Fax:713-583-1504
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health