Provider Demographics
NPI:1548493851
Name:INGRAHAM, STACY KAY (MSED, LPCC-S)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:KAY
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:MSED, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1206
Mailing Address - Country:US
Mailing Address - Phone:614-314-8864
Mailing Address - Fax:
Practice Address - Street 1:6371 RIVERSIDE DR STE 1800
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5440
Practice Address - Country:US
Practice Address - Phone:614-695-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0700419 SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional