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General NPI Number Information
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NPI Number | 1417102161
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Entity Type | Individual
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Provider Name | MRS. LIISA NOEL FERGUSON
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Gender | Female
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 9300 NE OAK VIEW DR
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City | VANCOUVER
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State | WA
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Zip | 98662-6347
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Country | US
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Telephone | 360-567-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 NE HOLMAN ST
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City | PORTLAND
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State | OR
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Zip | 97211-6067
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Country | US
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Telephone | 971-219-4740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | GT224008F
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License Number State | ID
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