Provider Demographics
NPI:1912166364
Name:INGRAM, MARK JAMES (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JAMES
Last Name:INGRAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9421 E 95TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6166
Mailing Address - Country:US
Mailing Address - Phone:918-557-8476
Mailing Address - Fax:
Practice Address - Street 1:9421 E 95TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6166
Practice Address - Country:US
Practice Address - Phone:918-557-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional