Healthcare Provider Details

I. General information

NPI: 1992449375
Provider Name (Legal Business Name): HALEY FERGUSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S PINE ISLAND RD STE 300
PLANTATION FL
33324-2665
US

IV. Provider business mailing address

17195 SW 49TH PL
MIRAMAR FL
33027-4919
US

V. Phone/Fax

Practice location:
  • Phone: 954-860-3742
  • Fax:
Mailing address:
  • Phone: 786-506-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: