Healthcare Provider Details

I. General information

NPI: 1720564560
Provider Name (Legal Business Name): LAURYNDA FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 SW 93RD ST
OKLAHOMA CITY OK
73159-6715
US

IV. Provider business mailing address

2608 SW 93RD ST
OKLAHOMA CITY OK
73159-6715
US

V. Phone/Fax

Practice location:
  • Phone: 714-975-4443
  • Fax:
Mailing address:
  • Phone: 714-975-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43108
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-19390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: