Healthcare Provider Details

I. General information

NPI: 1609408103
Provider Name (Legal Business Name): REBECCA AUTUMN FERGUSON MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 W HUNTSVILLE AVE STE B
SPRINGDALE AR
72762-2600
US

IV. Provider business mailing address

2112 W HUNTSVILLE AVE STE B
SPRINGDALE AR
72762-2600
US

V. Phone/Fax

Practice location:
  • Phone: 479-334-7293
  • Fax: 479-358-1476
Mailing address:
  • Phone: 479-334-7293
  • Fax: 479-358-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2109004
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2109004
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: