Provider Demographics
NPI:1497447684
Name:INGRAM, GARY LANCE JR (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LANCE
Last Name:INGRAM
Suffix:JR
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MILLERS XING STE 4
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5660
Mailing Address - Country:US
Mailing Address - Phone:254-953-7100
Mailing Address - Fax:
Practice Address - Street 1:302 MILLERS XING STE 4
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5660
Practice Address - Country:US
Practice Address - Phone:254-953-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84461101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health