Kim Michelle Childress

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6451015430 Issued in MI

Practice address

3300 36TH St SE
Kentwood, MI 49512-2810

Phone

(616) 304-7517

NPI assigned

Mar 4, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kim Broome Childress Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childress Counseling PLLC

  • Professional Counselor
  • Grandville, MI
  • NPI 1689152225
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1124410808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 36TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495122810",
            "telephone_number": "616-304-7517",
            "fax_number": "616-245-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 36TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495122810",
            "telephone_number": "616-304-7517"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3181 Prairie St SW Ste 104",
            "address_purpose": "LOCATION",
            "city": "Grandville",
            "state": "MI",
            "postal_code": "494182076",
            "country_code": "US",
            "telephone_number": "616-304-7517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "KIM",
        "middle_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-04",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6451015430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "CHILDRESS",
            "middle_name": "BROOME",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Edith Cervantes
• Dajane Capri Mone Chapman
• Iain Gemmell Charnley, M.D.
• Lucan Watt Chatterley, DO
• Angela Chesser, LLMSW
• Debbie S Cho
• Randall M Christenson, MD
• Cindy L Haner Velzen LMSW LLC
• Tia Esta Cisler, DPT
• Kaytelynne Athena Marie Clark

• Professional Counselor in Kentwood, MI
• Providers in Kentwood, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.