Healthcare Provider Details

I. General information

NPI: 1851837157
Provider Name (Legal Business Name): KEITH OSO ENGEL LCSW, BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 N COURTHOUSE RD
PROVIDENCE FORGE VA
23140-3408
US

IV. Provider business mailing address

1731 UPLAND RD
WAXAHACHIE TX
75165-1677
US

V. Phone/Fax

Practice location:
  • Phone: 804-409-7525
  • Fax: 804-315-9380
Mailing address:
  • Phone: 804-409-7525
  • Fax: 804-315-9380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08930124830
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012219
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: