MEDICARE: RICHARD FERGUSON III BCBA, LBA

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	0133001147	VA

General Provider Information

NPI Number	:	1962096040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD FERGUSON III BCBA, LBA

Provider Business Mailing Address
First Line	:	131 ROYAL CIR
Second Line	:
City	:	MADISON HTS
State	:	VA
Zip	:	24572-5013
Country	:	US
Telephone Number	:	434-420-4831
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 ROYAL CIR
Second Line	:
City	:	MADISON HTS
State	:	VA
Zip	:	24572-5013
Country	:	US
Telephone Number	:	434-420-4831
Fax Number	:

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

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/02/2021

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