Provider Demographics
NPI:1013901727
Name:CHAUHAN, PUSHPA N (PSY D)
Entity Type:Individual
Prefix:DR
First Name:PUSHPA
Middle Name:N
Last Name:CHAUHAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 BROADWAY BLVD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2593
Mailing Address - Country:US
Mailing Address - Phone:972-840-9900
Mailing Address - Fax:972-840-9980
Practice Address - Street 1:3960 BROADWAY BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2593
Practice Address - Country:US
Practice Address - Phone:972-840-9900
Practice Address - Fax:972-840-9980
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30862103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612150Medicare ID - Type Unspecified