Healthcare Provider Details

I. General information

NPI: 1265763734
Provider Name (Legal Business Name): VIRGINIA PAT MURPHY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIRGINIA MURPHY GUNNIN

II. Dates (important events)

Enumeration Date: 01/23/2010
Last Update Date: 01/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 AVERY DR APT 2210
FORT WORTH TX
76132-3890
US

IV. Provider business mailing address

6111 AVERY DR APT 2210
FORT WORTH TX
76132-3890
US

V. Phone/Fax

Practice location:
  • Phone: 214-729-4373
  • Fax:
Mailing address:
  • Phone: 214-729-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08211
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: