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CLYDE CHILDRESS JR.
NPI 1376998898
Counselor in San Rafael, CA

Active since May 03, 2016
1466 LINCOLN AVE, SAN RAFAEL, CA 94901(415) 457-3755 Get Directions Write a Review

NPPES record last updated: May 3, 2016. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Clyde Childress Jr. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLYDE CHILDRESS JR. (NPI 1376998898) is an individual counselor in San Rafael, California, licensed in California (C1106010028) and active in the NPI registry since May 2016.

NPPES Registry Identity

NPI1376998898
Entity TypeIndividualMale
Primary Taxonomy101Y00000X
Provider Legal NameCLYDE CHILDRESS JR.
Location Address1466 LINCOLN AVESan Rafael, CA 94901-2021
Mailing Address1466 Lincoln AveSan Rafael, CA 94901-2021
Phone(415) 457-3755
Sole ProprietorYes
Enumeration DateMay 3, 2016
✔ NPI 1376998898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
License✔ Licensed in CA · C1106010028
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
1466 LINCOLN AVE, San Rafael, CA 94901
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHRISTOPHER A JEFFERSON
Marriage & Family Therapist
1466 LINCOLN AVE
SAN RAFAEL, CA 94901
Marin County (805) 766-9426
LAVENIA BROWN
Counselor (Addiction (Substance Use Disorder))
1466 LINCOLN AVE
SAN RAFAEL, CA 94901
Marin County (415) 457-3755
MR. JEFFREY BENSON
Counselor
1466 LINCOLN AVE
SAN RAFAEL, CA 94901
Marin County (415) 457-3755
MS. DIANA HOROWITZ
Counselor
1466 LINCOLN AVE
SAN RAFAEL, CA 94901
Marin County (415) 457-3755
MR. JAMES WARREN M.F.T.I.
Marriage & Family Therapist
1466 LINCOLN AVE
SAN RAFAEL, CA 94901
Marin County (415) 457-3755
ELIZABETH GRUBER
Nurse Practitioner (Psychiatric/Mental Health)
1466 LINCOLN AVE
SAN RAFAEL, CA 94901
Marin County (502) 702-9929
VEASNA NGOR
Licensed Vocational Nurse
1466 LINCOLN AVE
SAN RAFAEL, CA 94901
Marin County (415) 457-3755
MR. JASON MCMONAGLE
Counselor
1466 LINCOLN AVE
SAN RAFAEL, CA 94901
Marin County (415) 457-3755

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clyde Childress's NPI number?

The NPI number for Clyde Childress is 1376998898. It was assigned to this individual provider in the NPPES registry on May 3, 2016.

Where is Clyde Childress located?

Clyde Childress practices at 1466 Lincoln Ave, San Rafael, CA 94901. The listed phone number is (415) 457-3755.

What is Clyde Childress's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

When was this NPI record last updated?

The NPPES record for Clyde Childress was last updated on May 3, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.