Ingram, Jennifer Mavrick

Ingram, Jennifer Mavrick is an individual health care provider with primary practice located at 1301 Seminole Blvd Suite 103, Largo FL 33770-8173. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Ingram, Jennifer Mavrick can be contacted via phone (727) 213-5379.

Contact Information

Primary practice address
1301 Seminole Blvd Suite 103 Largo FL 33770-8173
Phone: (727) 213-5379
Fax: (272) 213-5370
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 2868 Florida
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH8176 Florida

Profile Details

NPI number 1114125978
LBN Legal business name Ingram, Jennifer Mavrick
Credentials LMHC, CAP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 3rd, 2007
Last updated Jul 18th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114125978 NPPES
Florida Other 11691411 CAQH ID NUMBER

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