Provider Demographics
NPI:1427158799
Name:MICHELLE B VIRO PHD PA
Entity type:Organization
Organization Name:MICHELLE B VIRO PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:VIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-831-9852
Mailing Address - Street 1:175 LAKEFRONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:281-831-9852
Mailing Address - Fax:281-313-4676
Practice Address - Street 1:916 EAST BLANCO ROAD
Practice Address - Street 2:BUILDING 200
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:281-831-9852
Practice Address - Fax:281-313-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1954Medicare ID - Type Unspecified