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NPI Code Detail

MEDICARE: BETH MARIE INGRAM MFT

MEDICARE: BETH MARIE INGRAM MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC29342CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MFC29342OTHERCAMARRIAGE/FAMILY THERAPIST

General Provider Information

NPI Number : 1952411910
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH MARIE INGRAM MFT
Provider Business Mailing Address
First Line : 3164 CONDO CT
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-2557
Country : US
Telephone Number : 707-360-1900
Fax Number : 707-523-0133
Provider Business Practice Location Address
First Line : 341 IRWIN LN
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-5603
Country : US
Telephone Number : 707-576-7218
Fax Number : 707-576-7243
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 12/30/2021

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