Provider Demographics
NPI:1346888112
Name:VIRO, MICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VIRO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 LAKE FRONT DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5630
Mailing Address - Country:US
Mailing Address - Phone:281-831-9852
Mailing Address - Fax:
Practice Address - Street 1:916 E BLANCO RD STE 200
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1763
Practice Address - Country:US
Practice Address - Phone:281-831-9852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical