Provider Demographics
NPI:1720001944
Name:CHOWDHURY, INGRID (PHD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MONTANA AVE.
Mailing Address - Street 2:STE L
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5617
Mailing Address - Country:US
Mailing Address - Phone:915-587-1091
Mailing Address - Fax:915-587-1094
Practice Address - Street 1:1401 MONTANA AVE
Practice Address - Street 2:STE L
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5617
Practice Address - Country:US
Practice Address - Phone:915-587-1091
Practice Address - Fax:915-587-1094
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2190106H00000X
TX24555103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099515102Medicaid
TX00N16COtherUNSPECIFIED
TX00N16COtherUNSPECIFIED