Provider Demographics
NPI:1225535594
Name:INGRAM, AMIEE (BS, MATS)
Entity Type:Individual
Prefix:
First Name:AMIEE
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:BS, MATS
Other - Prefix:
Other - First Name:AMIEE
Other - Middle Name:
Other - Last Name:HUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 S NORTON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3296
Mailing Address - Country:US
Mailing Address - Phone:765-664-0101
Mailing Address - Fax:
Practice Address - Street 1:317 S NORTON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3296
Practice Address - Country:US
Practice Address - Phone:765-664-0101
Practice Address - Fax:765-668-8391
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMATS272101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)