MEDICARE: AMARILLO MARRIAGE AND FAMILY INSTITUTE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	16153	TX

General Provider Information

NPI Number	:	1639629959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMARILLO MARRIAGE AND FAMILY INSTITUTE INC

Provider Business Mailing Address
First Line	:	808 CRAFT CENTER RD
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79118-3743
Country	:	US
Telephone Number	:	806-350-5861
Fax Number	:	806-358-4345

Provider Business Practice Location Address
First Line	:	4211 W I 40 STE 101
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-6000
Country	:	US
Telephone Number	:	806-350-3133
Fax Number	:	806-358-4345

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	VIRGINIA L MONK
Credential	:	M.ED., LPC-S
Telephone Number	:	806-350-5861

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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