Healthcare Provider Details

I. General information

NPI: 1093622367
Provider Name (Legal Business Name): JUDI FERGUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2473 CARE DR STE 101
TALLAHASSEE FL
32308-9815
US

IV. Provider business mailing address

1253 WILLIAMS LANDING RD
TALLAHASSEE FL
32310-8282
US

V. Phone/Fax

Practice location:
  • Phone: 850-988-5009
  • Fax: 912-230-9514
Mailing address:
  • Phone: 912-230-9514
  • Fax: 912-230-9514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDI E FERGUS
Title or Position: LMHC
Credential: FERGUS
Phone: 912-230-9514