Healthcare Provider Details

I. General information

NPI: 1104909811
Provider Name (Legal Business Name): TRICIA MARSHALL-FERGUSON LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WHITNEY AVE SUITE 128B
GRETNA LA
70056-2558
US

IV. Provider business mailing address

401 WHITNEY AVE 604
GRETNA LA
70056
US

V. Phone/Fax

Practice location:
  • Phone: 504-994-9193
  • Fax: 504-309-7845
Mailing address:
  • Phone: 504-362-0504
  • Fax: 504-463-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3134
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1029
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2203783236
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: