Provider Demographics
NPI:1669444386
Name:LIM, INGRID CHARMAINE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:CHARMAINE
Last Name:LIM
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:INGRID
Other - Middle Name:CHARMAINE LIM
Other - Last Name:JURICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:3851 ROGER BROOKE DR
Mailing Address - Street 2:MCHE-QD
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4501
Mailing Address - Country:US
Mailing Address - Phone:210-916-7923
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-5447
Practice Address - Fax:808-433-5460
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1206103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent