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General NPI Number Information
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NPI Number | 1497576110
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Entity Type | Individual
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Provider Name | KIM FERGUSON LAC
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Gender | Female
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 128 SOUTHWINDS RD STE 5
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City | FARMINGTON
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State | AR
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Zip | 72730-8685
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Country | US
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Telephone | 479-466-0716
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Fax |
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Provider Business Mailing Address
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Address Line | 7302 W JOHN GARRISON RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-9475
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A2001016
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License Number State | AR
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