Kimberely L Ingram, LPC
Individual provider Active NPI Professional Counselor · Salem, MO
NPI 1790761617 · NPPES record last updated Mar 27, 2019
Key facts
- NPI
- 1790761617
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 002631 (MO)
- Practice address
- 913 S Pershing Ave
Salem, MO 65560-1845 - Phone
- (888) 403-1071
- NPI assigned
- Dec 22, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
119 W 4TH St
Salem, MO 65560-1255
Phone (573) 247-6086
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240320000162 | MO | Practitioner - Mental Health Counselor | 2668819152 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002631 | MO | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Faith Counseling, LLC | Current |
Accepting new patients |
Locations
119 W 4th St
Salem, MO 65560
Phone (573) 247-6086
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 002631 | MO | Yes |
Addresses
Primary practice location
913 S Pershing Ave
Salem, MO 65560-1845
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 495023707 | Medicaid | MO |
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All providers in Salem, MO · Professional Counselor in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.