Provider Demographics
NPI:1346856614
Name:INGRAM-BARNETT, JODIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:INGRAM-BARNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S ROYALL ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4437
Mailing Address - Country:US
Mailing Address - Phone:903-724-1322
Mailing Address - Fax:
Practice Address - Street 1:305 E LACY ST STE 120
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-2990
Practice Address - Country:US
Practice Address - Phone:903-724-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX416301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical