Active NPI
Jennifer Mavrick Ingram, LMHC, CAP
- Mental Health Counselor
- Largo, FL
National Provider Identifier
1114125978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH8176
- Practice address
- 1301 Seminole Blvd
Suite 103
Largo, FL 33770-8173 - Phone
- (727) 213-5379
- Fax
- (272) 213-5370
- NPI assigned
- Jul 3, 2007
- Last updated
- Jul 18, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 2868 | FL | |
| Mental Health Counselor | 101YM0800X | MH8176 | FL | Primary |
Addresses
Primary practice location
1301 Seminole Blvd
Suite 103
Largo, FL 33770-8173
Mailing address
1301 Seminole Blvd
Suite 103
Largo, FL 33770-8173
Phone (727) 213-5379
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11691411 | Other | FL | CAQH ID NUMBER |
Other names 1
- Jennifer Mavrick
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2868 | FL | MD | Addiction (Substance Use Disorder) Counselor |
| MH8176 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310947200000",
"number": "1114125978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 SEMINOLE BLVD",
"address_2": "SUITE 103",
"city": "LARGO",
"state": "FL",
"postal_code": "337708173",
"telephone_number": "727-213-5379",
"fax_number": "727-213-5370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 SEMINOLE BLVD",
"address_2": "SUITE 103",
"city": "LARGO",
"state": "FL",
"postal_code": "337708173",
"telephone_number": "727-213-5379",
"fax_number": "272-213-5370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "JENNIFER",
"middle_name": "MAVRICK",
"name_prefix": "Mrs.",
"credential": "LMHC, CAP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-03",
"last_updated": "2011-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "FL",
"license": "2868",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH8176",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH ID NUMBER",
"identifier": "11691411",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "MAVRICK",
"credential": "LMHC, CAP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Largo, FL
- Individual & Family Services Inc
- Leann Sarah Infante, BCBA
- Jeffrey Broughton Ingalls, D.M.D.
- Willilam L Ingham, HIS
- Sharetta Lanor Ingram-Patterson
- Inner Strength Counseling LLC
- Innovative Eyecare, P.a.
- Innovative Pharmacy Services LLC (Paragon Infusion Pharmacies)
- Innovision Practice Group PA (InnoVision)
- Jessica Alaine Inscho, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.