Healthcare Provider Details

I. General information

NPI: 1629148028
Provider Name (Legal Business Name): TAMMY M FERGUSON MA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 PACIFIC AVE STE 204
TACOMA WA
98402-4330
US

IV. Provider business mailing address

PO BOX 362
TACOMA WA
98401-0362
US

V. Phone/Fax

Practice location:
  • Phone: 206-779-7005
  • Fax:
Mailing address:
  • Phone: 206-779-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00008589
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: