Provider Demographics
NPI:1821762683
Name:INGRAM COUNSELING & PSYCHOTHERAPY SERVICES, INC
Entity Type:Organization
Organization Name:INGRAM COUNSELING & PSYCHOTHERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOROWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEYANN
Authorized Official - Middle Name:INGRAM
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC MCAP
Authorized Official - Phone:561-601-0235
Mailing Address - Street 1:1825 FOREST HILL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6058
Mailing Address - Country:US
Mailing Address - Phone:561-601-0235
Mailing Address - Fax:
Practice Address - Street 1:1825 FOREST HILL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6058
Practice Address - Country:US
Practice Address - Phone:561-601-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty