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

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

12080 Issued in MA

Practice address

867 Boylston St FL 5
Boston, MA 02116-2774

Phone

(740) 408-6407

NPI assigned

Sep 7, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Modern Soul Therapy LLC

  • Mental Health Counselor
  • Quincy, MA
  • NPI 1013516145
  NPD Authorized official

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769472000000",
    "number": "1275080293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "867 BOYLSTON ST FL 5",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021162774",
            "telephone_number": "740-408-6407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "867 BOYLSTON ST FL 5",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021162774",
            "telephone_number": "740-408-6407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "MALLORY",
        "name_prefix": "Ms.",
        "credential": "MA, LCPC, LMHC,R-DMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "12080",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.011231",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407971211",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew David Ingham, M.D.
• Ignacio Inglessis-Azuaje, MD
• Abbie Lynn Ingram, P.A.-C
• Elizabeth H Ingram, PA
• Kida Anne Ingram, PHD
• Kameron Melan Labio Inguito, MD
• Kara Ann Inkeles, PA-C
• Lesley A Inker, MD
• Inkyu Han, DMD, PLLC
• Daniel Charles Innamorato

• Mental Health Counselor in Boston, MA
• Providers in Boston, 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 Jan 27, 2026; 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.