Michael Ingram | Santa Rosa, CA • PECOS Search

Michael Ingram

Counselor

Behavioral Health & Social Service Providers

1300 Coddingtown Ctr, Santa Rosa, CA 95401-3537

PECOS Enrollment

Based on the most recent information from CMS, provider Michael Ingram does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1891961124
Provider Type
Individual
Full Name
Ingram, Michael
Gender
Male

Sole Proprietor
Yes
Enumeration Date
5/6/2008
Last Updated
5/6/2008

Contact Information

Practice Location

1300 Coddingtown Ctr, Santa Rosa, CA 95401-3537

Unlisted Fax

Mailing Location

1300 Coddingtown Ctr, Santa Rosa, CA 95401-3537

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YA0400X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer