Provider Demographics
NPI:1942430251
Name:ALLENSWORTH, VIRGINIA
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:ALLENSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 63 BOX 2100
Mailing Address - Street 2:107 N. 4410 RD.
Mailing Address - City:FT TOWSON
Mailing Address - State:OK
Mailing Address - Zip Code:74735-9256
Mailing Address - Country:US
Mailing Address - Phone:580-579-8172
Mailing Address - Fax:
Practice Address - Street 1:HC 63 BOX 2100
Practice Address - Street 2:107 N. 4410 RD.
Practice Address - City:FT TOWSON
Practice Address - State:OK
Practice Address - Zip Code:74735-9256
Practice Address - Country:US
Practice Address - Phone:580-579-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No171M00000XOther Service ProvidersCase Manager/Care Coordinator