Healthcare Provider Details

I. General information

NPI: 1831003557
Provider Name (Legal Business Name): ERIC INGRAHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 COURTHOUSE DR
CHARLOTTE MI
48813-1054
US

IV. Provider business mailing address

812 E JOLLY RD
LANSING MI
48910-6825
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-7162
  • Fax:
Mailing address:
  • Phone: 517-237-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: