Provider Demographics
NPI:1407944333
Name:MONGA, CHANDA R (MED; LMFT; PSY)
Entity Type:Individual
Prefix:MS
First Name:CHANDA
Middle Name:R
Last Name:MONGA
Suffix:
Gender:F
Credentials:MED; LMFT; PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1924
Mailing Address - Country:US
Mailing Address - Phone:214-750-6411
Mailing Address - Fax:214-750-6411
Practice Address - Street 1:12890 HILLCREST RD
Practice Address - Street 2:#200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1504
Practice Address - Country:US
Practice Address - Phone:214-455-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001688-042409106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBSPROVIDER#00239BOtherBLUECROSS BLUE SHIELD