Healthcare Provider Details

I. General information

NPI: 1427701549
Provider Name (Legal Business Name): JENSA FERGUSON, LMHC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 SHILSHOLE AVE NW STE 510
SEATTLE WA
98107-4040
US

IV. Provider business mailing address

23830 78TH AVE W
EDMONDS WA
98026-8821
US

V. Phone/Fax

Practice location:
  • Phone: 206-619-7628
  • Fax:
Mailing address:
  • Phone: 206-473-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENIFER L FERGUSON
Title or Position: OWNER, PRESIDENT
Credential: LMHC
Phone: 206-619-7628