MEDICARE: MIKELA FERGUSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CTB-2023-0882	NM

General Provider Information

NPI Number	:	1437923109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKELA FERGUSON

Provider Business Mailing Address
First Line	:	5924 OLEASTER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-2344
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5924 OLEASTER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-2344
Country	:	US
Telephone Number	:	915-244-8859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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