MEDICARE: REJINA FERGUSON-MCDOWELL

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
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	07007	NV

General Provider Information

NPI Number	:	1891278982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REJINA FERGUSON-MCDOWELL

Provider Business Mailing Address
First Line	:	10245 S MARYLAND PKWY UNIT 283
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4048
Country	:	US
Telephone Number	:	702-573-4865
Fax Number	:

Provider Business Practice Location Address
First Line	:	10245 S MARYLAND PKWY UNIT 283
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4048
Country	:	US
Telephone Number	:	702-981-9787
Fax Number	:

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

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	01/19/2023

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