MEDICARE: LAURYNDA 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	103K00000X	Behavior Analyst	1-20-43108	OK
2	106S00000X	Behavior Technician	RBT-16-19390	CA

General Provider Information

NPI Number	:	1720564560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURYNDA FERGUSON

Provider Business Mailing Address
First Line	:	2608 SW 93RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6715
Country	:	US
Telephone Number	:	714-975-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 SW 93RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6715
Country	:	US
Telephone Number	:	714-975-4443
Fax Number	:

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

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	05/18/2026

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Directions to “ LAURYNDA FERGUSON ” Practice Location

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