Healthcare Provider Details

I. General information

NPI: 1861321747
Provider Name (Legal Business Name): AMEENA MARIE IGRAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4983 RIDGE RD
WADSWORTH OH
44281-9738
US

IV. Provider business mailing address

3300 MONROE AVE UNIT FRONT
CLEVELAND OH
44113-3994
US

V. Phone/Fax

Practice location:
  • Phone: 419-681-4241
  • Fax:
Mailing address:
  • Phone: 440-454-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608061
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: