Healthcare Provider Details

I. General information

NPI: 1609699644
Provider Name (Legal Business Name): FERGUSON BEHAVIOR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 CELINA AVE
AKRON OH
44307-1616
US

IV. Provider business mailing address

981 CELINA AVE
AKRON OH
44307-1616
US

V. Phone/Fax

Practice location:
  • Phone: 330-907-4391
  • Fax:
Mailing address:
  • Phone: 330-907-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY L FERGUSON
Title or Position: OWNER
Credential:
Phone: 330-907-4391