Active NPI
Timothy Leon Ingram, M.ED.
- Mental Health Counselor
- Jacksonville, FL
National Provider Identifier
1003966474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH1575
- Practice address
- 9951 Atlantic Blvd
Ste 170
Jacksonville, FL 32225-6584 - Phone
- (904) 482-4105
- Fax
- (904) 482-4106
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH1575 | FL | Primary |
Addresses
Primary practice location
9951 Atlantic Blvd
Ste 170
Jacksonville, FL 32225-6584
Mailing address
113 Pine St
Neptune Beach, FL 32266-6050
Phone (904) 249-5439
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH1575 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245369600000",
"number": "1003966474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 PINE ST",
"city": "NEPTUNE BEACH",
"state": "FL",
"postal_code": "322666050",
"telephone_number": "904-249-5439",
"fax_number": "904-482-4106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9951 ATLANTIC BLVD",
"address_2": "STE 170",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322256584",
"telephone_number": "904-482-4105",
"fax_number": "904-482-4106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "TIMOTHY",
"middle_name": "LEON",
"name_prefix": "Mr.",
"credential": "M.ED.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2009-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH1575",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.