Provider Demographics
NPI:1265971766
Name:INGRAM, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23650 HIGHLINER WAY
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-3348
Mailing Address - Country:US
Mailing Address - Phone:817-781-4456
Mailing Address - Fax:
Practice Address - Street 1:23620 THREE NOTCH RD UNIT 101
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-3083
Practice Address - Country:US
Practice Address - Phone:240-544-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst