Individual
CAROLYN MAVIS INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
6216 S LEWIS AVE, SUITE 180, TULSA, OK 74136-1044
(918) 960-7852
Mailing address
546 E PINE PL, TULSA, OK 74106-4340
(918) 587-5165
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/21/2012
Last updated
09/21/2012
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