Provider Demographics
NPI:1194365262
Name:INGRAM, ALEXIS C (PCCSS)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:C
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PCCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W WILLIE MORRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-7702
Mailing Address - Country:US
Mailing Address - Phone:662-746-5712
Mailing Address - Fax:
Practice Address - Street 1:635 W WILLIE MORRIS PKWY
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-7702
Practice Address - Country:US
Practice Address - Phone:662-746-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health