Provider Demographics
NPI:1568758407
Name:INGRAM, CASSANDRA LEE (MS, LPE-I)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MS, LPE-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-0414
Mailing Address - Country:US
Mailing Address - Phone:501-679-0232
Mailing Address - Fax:833-373-0348
Practice Address - Street 1:8 S BROADVIEW ST STE EANDF
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9601
Practice Address - Country:US
Practice Address - Phone:501-679-0232
Practice Address - Fax:833-373-0348
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
AR13-14EI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist