Provider Demographics
NPI:1447930342
Name:INGRAM, MARGARET LYNN
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:LYNN
Last Name:INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5161 SOQUEL DR STE C
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2560
Mailing Address - Country:US
Mailing Address - Phone:831-818-8264
Mailing Address - Fax:
Practice Address - Street 1:5161 SOQUEL DR STE C
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2560
Practice Address - Country:US
Practice Address - Phone:831-515-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional