KIM MICHELLE CHILDRESS (NPI# 1124410808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124410808 |
| Entity Type | Individual |
| Full Name | KIM MICHELLE CHILDRESS |
| Other Name | KIM BROOME CHILDRESS |
| Practice Address |
4565 Wilson Ave Sw Ste 3a Grandville MI 49418 |
| Mailing Address |
1939 S Division Ave Grand Rapids MI 49507 |
| Practice Telephone | 6164663107 |
| Mailing Telephone | 6162473815 |
| Mailing Fax Number | 6162450450 |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2018-10-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
6401015430 | MI | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1101 Ball Ave Ne, Grand Rapids, MI 495055904 | 6163047517 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528424058 | Kim Childress | Community Health Worker | 13500 Se 7th St, Vancouver, WA 98683-6909 | 2016-01-13 |
| Street Address |
4565 WILSON AVE SW STE 3A |
| City | GRANDVILLE |
| State | MI |
| Zip Code | 49418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356985386 | Matthew M Schmuker | Counselor | 4565 Wilson Ave Sw Ste 3a, Grandville, MI 49418-2371 | 2019-11-02 |
| 1689152225 | Childress Counseling Pllc | Counselor | 4565 Wilson Ave Sw Ste 3a, Grandville, MI 49418-2371 | 2018-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144799669 | Holly Cieslinski | Occupational Therapist | 3550 Fairlines Ave, Grandville, MI 49418 | 2018-11-14 |
| 1639664857 | Athletico Ltd | Physical Therapist | 3819 Rivertown Pkwy Sw Ste 100, Grandville, MI 49418 | 2018-06-29 |
| 1437651916 | Great Lakes Wellness Counseling LLC | Counselor | 2900 Wilson Ave Suite 110, Grandville, MI 49418 | 2018-03-01 |
| 1780111765 | Jenna Sargent | Nurse Practitioner | 2845 44th St Sw, Ste 200, Grandville, MI 49418 | 2017-05-22 |
| 1881132827 | Laura Elizabeth Ramaker | Specialist/Technologist | 2787 Pine Dunes Ct Sw, Wyoming, MI 49418 | 2017-02-10 |
| 1689026130 | Charles Unseld | Hearing Instrument Specialist | O-38 44th St Sw, Grandville, MI 49418 | 2016-07-08 |
| 1972989655 | Laci Dawn Johncock | Physical Therapy Assistant | 2786 56th Street, Wyoming, MI 49418 | 2015-08-05 |
| 1891178570 | Joshua Kolman | Pharmacist | 3434 Century Center Dr Sw, Grandville, MI 49418 | 2015-06-30 |
| 1710368782 | Tracie Medrano- Smith | Family Medicine | 4174 56th St Sw, Wyoming, MI 49418 | 2015-06-15 |
| 1639593627 | Burke Group Counseling & Consulting Professionals LLC | Counselor | 4301 Canal St, Suite M, Grandville, MI 49418 | 2014-02-11 |
| Find all providers in zip 49418 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437651916 | Great Lakes Wellness Counseling LLC | Counselor | 2900 Wilson Ave Suite 110, Grandville, MI 49418 | 2018-03-01 |
| 1720471311 | Meredith Persenaire | Counselor | 185 44th St Sw Ste E, Grandville, MI 49418-3363 | 2015-03-06 |
| 1629488036 | Betty Lowell | Counselor | 2855 44th St Sw Ste 165, Grandville, MI 49418-2682 | 2014-05-07 |
| 1639593627 | Burke Group Counseling & Consulting Professionals LLC | Counselor | 4301 Canal St, Suite M, Grandville, MI 49418 | 2014-02-11 |
| 1235566316 | Laura Leigh Stylez | Counselor | 4445 Heritage Ct Sw, Grandville, MI 49418-2658 | 2013-10-03 |
| 1275808594 | Henderson Counseling Services, LLC | Counselor | 4565 Wilson Ave Sw Ste 1a, Grandville, MI 49418-2371 | 2012-03-20 |
| 1295037745 | Karen Dawn Appleton | Counselor | 4175 Parkway Place Dr Sw Ste 104, Grandville, MI 49418-2382 | 2010-12-02 |
| 1073728291 | Andrea Christine Lehman | Counselor | 2976 Ivanrest Ave Sw 205, Grandville, MI 49505-4066 | 2007-05-11 |
| 1609090612 | Mary Ann Shuman | Counselor | 2976 Ivanrest, Suite 205, Grandville, MI 49418-1440 | 2007-04-12 |
| 1356985386 | Matthew M Schmuker | Counselor | 4565 Wilson Ave Sw Ste 3a, Grandville, MI 49418-2371 | 2019-11-02 |
| Find all providers in GRANDVILLE | ||||
| City | GRANDVILLE |
| Zip Code | 49418 |
Please comment or provide details below to improve the information on KIM MICHELLE CHILDRESS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.