Provider Demographics
NPI:1639244395
Name:INGRAM, KERRY D IX (LPC)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:D
Last Name:INGRAM
Suffix:IX
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W RACE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4237
Mailing Address - Country:US
Mailing Address - Phone:501-827-6160
Mailing Address - Fax:501-400-7929
Practice Address - Street 1:120 W RACE AVE STE 2
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4237
Practice Address - Country:US
Practice Address - Phone:501-827-6160
Practice Address - Fax:501-400-7929
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0801006101YM0800X
ARP1012078101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health