Provider Demographics
NPI:1265069496
Name:INGRAM, ROBIN (LPCC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DON TOMAS
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-9607
Mailing Address - Country:US
Mailing Address - Phone:505-206-6725
Mailing Address - Fax:
Practice Address - Street 1:30 DON TOMAS
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9607
Practice Address - Country:US
Practice Address - Phone:505-206-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0922101YM0800X
NMCMH0206661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5052066725Medicaid
NM03423760Medicaid