MARISSA ANN CHILDRESS, LCSW — NPI 1639914625 (Licensed & Credentialed Social Worker in LOCKHART, TX)

CMS-1500 Box 24J / 33a • NPI

1639914625

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

104100000X

Licensed & Credentialed Social Worker

Box 32 Service Location & ZIP+4

1100 STATE PARK RD STE 109, LOCKHART, TX, 78644-3832

✓ 9-Digit EDI 837 ZIP+4 (78644-3832)

Practice Phone & Referral Fax

(512) 537-5797

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1639914625 (MARISSA ANN CHILDRESS, LCSW) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1639914625` (NPI-1 Individual Practitioner)
Provider / Legal Name	MARISSA ANN CHILDRESS, LCSW
Plain-English Specialty	Licensed & Credentialed Social Worker NUCC Code: `104100000X` (Social Worker)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1100 STATE PARK RD STE 109, LOCKHART, TX, 78644-3832
Practice Telephone / Fax	Tel: (512) 537-5797
Administrative Mailing Address	430 FARMERS RD, MAXWELL, TX, 78656-4283
Enumeration & Last Sync	Enumerated: 2024-07-01 \| CMS Record Updated: 2024-07-01

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1100 STATE PARK RD STE 109, LOCKHART, TX, 78644-3832

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Plain-English Taxonomy & CMS Crosswalk (104100000X)

What Does Taxonomy Code 104100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 104100000X translates to:
"Licensed & Credentialed Social Worker"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Social Worker for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MARISSA ANN CHILDRESS, LCSW)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`104100000X` — Social Worker Plain English: Licensed & Credentialed Social Worker	State: TX \| License: `105196` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MARISSA ANN CHILDRESS, LCSW (NPI #1639914625)