Childress, Woody Cal
Childress, Woody Cal is an sole proprietor health care provider with primary practice located at 5658 Westcreek Dr Ste 400 , Fort Worth TX 76133-2254. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / School. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Childress, Woody Cal can be contacted via phone (817) 731-2468.Contact Information
Primary practice address
5658 Westcreek Dr Ste 400
Fort Worth TX 76133-2254
Phone: (817) 731-2468
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 2-3301 | Texas |
| Behavioral Health & Social Service Providers / School | 103TS0200X | 6637 | Texas |
Profile Details
| NPI number | 1013064534 |
|---|---|
| LBN Legal business name | Childress, Woody Cal |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 5th, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013064534 | NPPES |
| Texas | MEDICAID | P000D92R2 |
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