Provider Demographics
NPI:1205528585
Name:INGRAM, TIFFANY (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11356 PALMETTO LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-5993
Mailing Address - Country:US
Mailing Address - Phone:225-278-9973
Mailing Address - Fax:
Practice Address - Street 1:8175 VINCENT RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-6359
Practice Address - Country:US
Practice Address - Phone:225-278-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA141181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical