Provider Demographics
NPI:1639263247
Name:INGLE, CHARLES G (LMHC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:INGLE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 430
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50228
Mailing Address - Country:US
Mailing Address - Phone:515-994-2617
Mailing Address - Fax:515-994-2365
Practice Address - Street 1:100 E. JEFFERSON
Practice Address - Street 2:
Practice Address - City:PRAIRIE CITY
Practice Address - State:IA
Practice Address - Zip Code:50228
Practice Address - Country:US
Practice Address - Phone:515-994-2617
Practice Address - Fax:515-994-2365
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health