Provider Demographics
NPI:1760789010
Name:INGLE-MUNOZ, DEBRA DIANCA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:DIANCA
Last Name:INGLE-MUNOZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:DIANCA
Other - Last Name:INGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:WBAMC, 5005 N. PIEDRAS
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920
Mailing Address - Country:US
Mailing Address - Phone:915-742-8233
Mailing Address - Fax:915-742-4891
Practice Address - Street 1:WBAMC, 5005 N. PIEDRAS
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920
Practice Address - Country:US
Practice Address - Phone:915-742-8233
Practice Address - Fax:915-742-4891
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2019-10-18
Deactivation Date:2018-01-30
Deactivation Code:
Reactivation Date:2019-10-14
Provider Licenses
StateLicense IDTaxonomies
TX346921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649345869Medicaid