Provider Demographics
NPI:1114073426
Name:MONK, VIRGINIA L (LPC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:MONK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8451 KEMPER RD
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-7922
Mailing Address - Country:US
Mailing Address - Phone:806-656-0408
Mailing Address - Fax:
Practice Address - Street 1:4211 W INTERSTATE 40
Practice Address - Street 2:SUITE 203
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6053
Practice Address - Country:US
Practice Address - Phone:806-374-5950
Practice Address - Fax:806-358-4345
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2018-06-11
Deactivation Date:2018-05-31
Deactivation Code:
Reactivation Date:2018-06-11
Provider Licenses
StateLicense IDTaxonomies
TX16153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16153OtherLICENSE NUMBER