Verl O Childers Jr., PH. D.
Individual provider Active NPI Psychologist · Itasca, TX
NPI 1801908561 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1801908561
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 22103 (TX)
- Practice address
- 2994 FM 66
Itasca, TX 76055-5110 - Phone
- (254) 687-2494
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22103 | TX | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 22103 | TX | Yes |
Addresses
Primary practice location
2994 FM 66
Itasca, TX 76055-5110
Mailing address
2994 FM 66
Itasca, TX 76055-5110
Phone (254) 687-2494
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00SD07 | Other | TX | BLUE CROSS BLUE SHIELD |
Other providers in Itasca, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.