Healthcare Provider Details

I. General information

NPI: 1477071413
Provider Name (Legal Business Name): SARAH ROESCH FERGUSON LPC/MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 DIVISION ST STE 405
NASHVILLE TN
37203-4495
US

IV. Provider business mailing address

4235 HILLSBORO PIKE SUITE 300
NASHVILLE TN
37215
US

V. Phone/Fax

Practice location:
  • Phone: 615-274-8400
  • Fax:
Mailing address:
  • Phone: 615-274-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number275
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13066
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61395487
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134700TELE
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13305
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number701013880
License Number StateVA
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4823
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: