Provider Demographics
NPI:1578221560
Name:INGRAM, JESSICA KATHRYN (LPC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:KATHRYN
Last Name:INGRAM
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:RR 4 BOX 185X41
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77554-9634
Mailing Address - Country:US
Mailing Address - Phone:512-751-3964
Mailing Address - Fax:
Practice Address - Street 1:5225 KATY FWY STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2263
Practice Address - Country:US
Practice Address - Phone:832-479-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82702101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty