Provider Demographics
NPI:1801028063
Name:TREBS-INGRAM, JANET ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ELIZABETH
Last Name:TREBS-INGRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:ELIZABETH
Other - Last Name:TREBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:26902 SPARROW RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2332
Mailing Address - Country:US
Mailing Address - Phone:210-381-2092
Mailing Address - Fax:
Practice Address - Street 1:277 E AMADOR AVE STE 309
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3676
Practice Address - Country:US
Practice Address - Phone:210-381-2092
Practice Address - Fax:575-636-2500
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-08900104100000X
1041C0700X
TX618871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409729701Medicaid