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NPI Code Detail

MEDICARE: MR. CHRISTOPHER WADE FERGUSON MSW, QMHP

MEDICARE: MR. CHRISTOPHER WADE FERGUSON MSW, QMHP
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
1101YM0800XMental Health Counselor
2101Y00000XCounselor

General Provider Information

NPI Number : 1821122391
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTOPHER WADE FERGUSON MSW, QMHP
Provider Business Mailing Address
First Line : 11035 NE SANDY BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97220-2553
Country : US
Telephone Number : 541-221-8681
Fax Number :
Provider Business Practice Location Address
First Line : 1507 NE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-1911
Country : US
Telephone Number : 503-258-4228
Fax Number : 503-493-2656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 02/26/2019

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