Provider Demographics
NPI:1891877569
Name:INGRAM, CHARLOTTE G (LMHP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:G
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1680
Mailing Address - Country:US
Mailing Address - Phone:308-632-8547
Mailing Address - Fax:308-632-0135
Practice Address - Street 1:2622 AVENUE C
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1680
Practice Address - Country:US
Practice Address - Phone:308-632-8547
Practice Address - Fax:308-632-0135
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE232820OtherMIDLANDS CHOICE
NE47083791626Medicaid
NE84839OtherBLUE CROSS/BLUE SHIELD