Provider Demographics
NPI:1700986825
Name:INGMUNDSON, PAUL T (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:INGMUNDSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 BABCOCK RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4411
Mailing Address - Country:US
Mailing Address - Phone:210-340-1141
Mailing Address - Fax:210-344-3862
Practice Address - Street 1:2128 BABCOCK RD BLDG 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4411
Practice Address - Country:US
Practice Address - Phone:210-340-1141
Practice Address - Fax:210-344-3862
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical