Provider Demographics
NPI:1639629959
Name:AMARILLO MARRIAGE AND FAMILY INSTITUTE INC
Entity Type:Organization
Organization Name:AMARILLO MARRIAGE AND FAMILY INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONK
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC-S
Authorized Official - Phone:806-350-5861
Mailing Address - Street 1:808 CRAFT CENTER RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-3743
Mailing Address - Country:US
Mailing Address - Phone:806-350-5861
Mailing Address - Fax:806-358-4345
Practice Address - Street 1:4211 W I 40 STE 101
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6000
Practice Address - Country:US
Practice Address - Phone:806-350-3133
Practice Address - Fax:806-358-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty