Provider Demographics
NPI:1730873795
Name:INGRAM, GARRETT SR (PHD, MA, MFT)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:INGRAM
Suffix:SR
Gender:M
Credentials:PHD, MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:POCONO SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18346-1156
Mailing Address - Country:US
Mailing Address - Phone:646-584-5320
Mailing Address - Fax:
Practice Address - Street 1:1110 TRAPPER LN
Practice Address - Street 2:
Practice Address - City:POCONO SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18346-7830
Practice Address - Country:US
Practice Address - Phone:646-584-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health