Provider Demographics
NPI:1356547665
Name:INGRAHAM, LINDA M (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:INGRAHAM
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 1:3131 TURTLE CREEK BLVD
Mailing Address - Street 2:SUITE 1026
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5426
Mailing Address - Country:US
Mailing Address - Phone:214-219-1031
Mailing Address - Fax:214-522-0916
Practice Address - Street 1:3131 TURTLE CREEK BLVD
Practice Address - Street 2:SUITE 1026
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5426
Practice Address - Country:US
Practice Address - Phone:214-219-1031
Practice Address - Fax:214-522-0916
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22872103T00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B12AOtherBCBS
TX0320111Medicaid
TX00B12AMedicare ID - Type Unspecified