Provider Demographics
NPI:1760875058
Name:INGRAM, THOMAS LANE (LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LANE
Last Name:INGRAM
Suffix:
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 1:1210 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4133
Mailing Address - Country:US
Mailing Address - Phone:512-900-5805
Mailing Address - Fax:512-287-4314
Practice Address - Street 1:1210 PARKWAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4133
Practice Address - Country:US
Practice Address - Phone:512-900-5805
Practice Address - Fax:512-287-4314
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72859101YP2500X
IL180.008826101YP2500X
TX67118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional