# SHELLY INGRAM LCMFT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407480064
- **Authorized official:** SHELLY INGRAM (LCMFT)
- **Authorized official phone:** (316) 461-7923

## Contact information

- **Practice address:** 6525 E MAINSGATE RD, WICHITA, KS 67226-1062
- **Practice address phone:** (316) 461-7923
- **Mailing address:** 6525 E MAINSGATE RD, WICHITA, KS 67226-1062
- **Mailing address phone:** (866) 924-4634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2020
- **Last updated:** 03/07/2020