Organization
BEHAVIORAL PSYCHOLOGY CLINIC, PC
Active
Other names
The Rehab Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE C INGRAM PH.D. (LICENSED PSYHOLOGIST CEO)
(214) 339-2047
Entity
Organization
Contact information
Practice address
5201 S WESTMORELAND RD, DALLAS, TX 75237-1622
(214) 339-2047
(214) 339-2049
Mailing address
5201 S WESTMORELAND RD, DALLAS, TX 75237-1622
(214) 339-2047
(214) 339-2049
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2-3078
TX
103TB0200X
Cognitive & Behavioral Psychologist
2-3078
TX
103TC0700X
Clinical Psychologist
2-3078
TX
103TC1900X
Counseling Psychologist
2-3078
TX
103TR0400X
Rehabilitation Psychologist
2-3078
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034167901
—
TX
01
—
81678P
BCBS #
TX
Enumeration date
03/26/2007
Last updated
07/21/2010
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