Modern Soul Therapy LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MODERN SOUL THERAPY LLC

Practice address

120 Whitwell St Unit D-106
Quincy, MA 02169-1998

Phone

(740) 408-6407

NPI assigned

Oct 20, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mallory A Ingram, LMHC, LCPCNPI 1275080293

Title

Owner

Phone

(740) 408-6407

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mallory Ingram, MA, LCPC, LMHC,R-DMT

  • Mental Health Counselor
  • Boston, MA
  • NPI 1275080293
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1013516145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 WHITWELL ST UNIT D-106",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021691998",
            "telephone_number": "740-408-6407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 WHITWELL ST UNIT D-106",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021691998",
            "telephone_number": "740-408-6407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN SOUL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "MALLORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "740-408-6407",
        "authorized_official_credential": "LMHC, LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE",
            "identifier": "09322531",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• MK Dental, PLLC
• Lapatlada F. Mo, LICSW
• Farhad Modarai, D.O.
• Anne Modena, LICSW
• Modern Assistance Programs, Inc.
• Paula Moebus, LMFT
• Ahmed Hosni Mohamed
• Hawa Mohamed
• Nina Moliver, M.S.
• Michael T Mollins

• Mental Health Counselor in Quincy, MA
• Providers in Quincy, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.