Provider Demographics
NPI:1518331982
Name:INGRAM-COOPER, TYRONZA (LPC)
Entity Type:Individual
Prefix:
First Name:TYRONZA
Middle Name:
Last Name:INGRAM-COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SCENIC HWY # 1701-237
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6359
Mailing Address - Country:US
Mailing Address - Phone:770-841-8927
Mailing Address - Fax:
Practice Address - Street 1:1851 BECKETT CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6113
Practice Address - Country:US
Practice Address - Phone:770-841-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional