Provider Demographics
NPI:1821850645
Name:INGRAM, JOHN-ARTHUR (AMFT)
Entity Type:Individual
Prefix:
First Name:JOHN-ARTHUR
Middle Name:
Last Name:INGRAM
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 MILWOOD AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2831
Mailing Address - Country:US
Mailing Address - Phone:918-361-3932
Mailing Address - Fax:
Practice Address - Street 1:17777 VENTURA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3738
Practice Address - Country:US
Practice Address - Phone:213-908-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist