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General NPI Number Information
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NPI Number | 1639547763
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Entity Type | Organization
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Legal Business Name | ANNE ELISE INGHAM, PSY.D.
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Dates
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Enumeration Date | 09/06/2015
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Last Update Date | 09/06/2015
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Provider Practice Location Address
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Address Line | 550 HAMILTON AVE STE 320
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City | PALO ALTO
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State | CA
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Zip | 94301-2031
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Country | US
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Telephone | 650-391-6186
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Fax |
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Provider Business Mailing Address
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Address Line | 3772 LA DONNA AVE
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City | PALO ALTO
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State | CA
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Zip | 94306-3150
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. ANNE INGHAM
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Credential | PSY.D.
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Telephone | 650-391-6186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | PSY27362
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PSY27362
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License Number State | CA
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