Organization
INTEGRATED COUNSELING PRACTICE
Active
Other names
Ingram Counseling Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA INGRAM LMSW (EXECUTIVE DIRECTOR)
(712) 255-0232
Entity
Organization
Contact information
Practice address
1221 PIERCE ST, SIOUX CITY, IA 51105-1418
(712) 255-0232
(712) 255-0354
Mailing address
1221 PIERCE ST, SIOUX CITY, IA 51105-1418
(712) 255-0232
(712) 255-0354
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1284
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0791665
—
IA
01
—
29-97-059
RTSS CONTRACT NUMBER
IA
Enumeration date
06/26/2007
Last updated
05/30/2012
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