Healthcare Provider Details

I. General information

NPI: 1528265071
Provider Name (Legal Business Name): MELANIE R. FERGUSON PH.D., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 GRANT ST
MOBILE AL
36606-4714
US

IV. Provider business mailing address

2805 GRANT ST
MOBILE AL
36606-4714
US

V. Phone/Fax

Practice location:
  • Phone: 251-648-6192
  • Fax:
Mailing address:
  • Phone: 251-648-6192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number810
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: