Provider Demographics
NPI:1356406763
Name:INGRAM, CHASTITY ANN (LSCSW, LCSW, LMHP)
Entity type:Individual
Prefix:MRS
First Name:CHASTITY
Middle Name:ANN
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LSCSW, LCSW, LMHP
Other - Prefix:
Other - First Name:CHASTITY
Other - Middle Name:ANN
Other - Last Name:HARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:775 31 RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NE
Mailing Address - Zip Code:68939-5158
Mailing Address - Country:US
Mailing Address - Phone:308-470-1338
Mailing Address - Fax:
Practice Address - Street 1:775 31 RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NE
Practice Address - Zip Code:68939-5158
Practice Address - Country:US
Practice Address - Phone:308-470-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 24941041C0700X
NE13421041C0700X
NE8031041C0700X
NE36281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS070591OtherBCBS
KS070591Medicare ID - Type Unspecified