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General NPI Number Information
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NPI Number | 1922324409
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Entity Type | Individual
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Provider Name | MELISSA LYNN FERGUSON LPC
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Gender | Female
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 7105 S HIGHLAND DR STE 104
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-7316
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Country | US
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Telephone | 801-867-0462
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Fax |
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Provider Business Mailing Address
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Address Line | 5482 ROSE SUMMIT DRIVE
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City | HERRIMAN
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State | UT
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Zip | 84096
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Country | US
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Telephone | 801-983-5700
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Fax | 801-983-5701
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 15027438-6004
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License Number State | UT
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