Provider Demographics
NPI:1013027739
Name:FERGUSON, PAMELA SUZANNE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUZANNE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 CULVER DR
Mailing Address - Street 2:#203
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-552-0275
Mailing Address - Fax:949-552-0396
Practice Address - Street 1:14150 CULVER DR
Practice Address - Street 2:#203
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-552-0275
Practice Address - Fax:949-552-0396
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM17308106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist