Provider Demographics
NPI:1275048829
Name:INGRAM, JANELL M
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:M
Last Name:INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANELL
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 HAHN ST LOT 3
Mailing Address - Street 2:
Mailing Address - City:HAHNVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70057-2253
Mailing Address - Country:US
Mailing Address - Phone:504-402-9023
Mailing Address - Fax:
Practice Address - Street 1:139 HAHN ST LOT 3
Practice Address - Street 2:
Practice Address - City:HAHNVILLE
Practice Address - State:LA
Practice Address - Zip Code:70057-2253
Practice Address - Country:US
Practice Address - Phone:504-402-9023
Practice Address - Fax:504-402-9023
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health