Individual
MARK ANTHONY INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
7537 S BRADEN AVE, TULSA, OK 74136-8202
(918) 857-0269
Mailing address
7537 S BRADEN AVE, TULSA, OK 74136-8202
(918) 857-0269
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
635
OK
Other
Enumeration date
07/25/2011
Last updated
07/25/2011
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