Healthcare Provider Details

I. General information

NPI: 1134875545
Provider Name (Legal Business Name): BETH INGRAM & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 CRESCENT PARK DR
RIVERVIEW FL
33578-3605
US

IV. Provider business mailing address

602 VONDERBURG DR STE 201
BRANDON FL
33511-5900
US

V. Phone/Fax

Practice location:
  • Phone: 813-492-8686
  • Fax: 813-492-8479
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: VANESSA BANKS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 813-508-2991