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General NPI Number Information
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NPI Number | 1063530301
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL PSYCHOLOGY CLINIC, PC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 5201 S WESTMORELAND RD
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City | DALLAS
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State | TX
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Zip | 75237-1622
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Country | US
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Telephone | 214-339-2047
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Fax | 214-339-2049
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Provider Business Mailing Address
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Address Line | 5201 S WESTMORELAND RD
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City | DALLAS
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State | TX
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Zip | 75237-1622
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Country | US
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Telephone | 214-339-2047
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Fax | 214-339-2049
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Authorized Official
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Title or Position | LICENSED PSYHOLOGIST CEO
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Name | DR. JESSE C INGRAM
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Credential | PH.D.
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Telephone | 214-339-2047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 2-3078
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2-3078
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 2-3078
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 2-3078
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2-3078
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License Number State | TX
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