Jacqueline Olivia Childs

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

122336 Issued in CA

Practice address

251 Llewellyn Ave
Campbell, CA 95008-1940

Phone

(408) 379-3790

NPI assigned

Jun 6, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Jackie Olivia Childs Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Center for Learning and Autism Support Services, Inc.

  • Early Intervention Provider Agency
  • San Mateo, CA
  • NPI 1417139288

  Behavior Analyst

  NPD (past)

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

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1376992867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 LLEWELLYN AVE",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950081940",
            "telephone_number": "408-379-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 LLEWELLYN AVE",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950081940",
            "telephone_number": "408-379-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDS",
        "first_name": "JACQUELINE",
        "middle_name": "OLIVIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-06",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "F2928188",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "122336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "CHILDS",
            "middle_name": "OLIVIA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kellie Summer Cheves, RD
• Amy W CHI, OD
• Children'S Recovery Center 1, LLC
• Children'S Recovery Center 1, LLC
• Children'S Recovery Center, I LLC
• Chiropractic Health Center Inc. a Delaware Corporation
• Chitra Shanmugham, D.D.S., Inc
• Chin Chin Chiu, BCBA
• Joshua Ushik Choe
• John Yungho Choi, D.D.S.

• Marriage & Family Therapist in Campbell, CA
• Providers in Campbell, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.