Provider Demographics
NPI:1982071148
Name:VIRGIL, JOSEPH (MSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:VIRGIL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 NUFFIELD LANE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036
Mailing Address - Country:US
Mailing Address - Phone:720-301-7157
Mailing Address - Fax:
Practice Address - Street 1:424 NUFFIELD LANE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036
Practice Address - Country:US
Practice Address - Phone:720-301-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1982071148Medicaid