Provider Demographics
NPI:1215614680
Name:DERAS, INGRID S (LMFT-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:S
Last Name:DERAS
Suffix:
Gender:F
Credentials:LMFT-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10750 BARKER CYPRESS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2282
Mailing Address - Country:US
Mailing Address - Phone:346-357-4694
Mailing Address - Fax:
Practice Address - Street 1:10750 BARKER CYPRESS RD STE 104
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2282
Practice Address - Country:US
Practice Address - Phone:346-357-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health