Provider Demographics
NPI:1477183945
Name:INGRAM, DESIREE LU
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:LU
Last Name:INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2139
Mailing Address - Country:US
Mailing Address - Phone:541-482-1718
Mailing Address - Fax:541-482-0964
Practice Address - Street 1:607 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2139
Practice Address - Country:US
Practice Address - Phone:541-482-1718
Practice Address - Fax:541-482-0964
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health