Provider Demographics
NPI:1073088167
Name:FERGUSON, SHELLEIGH
Entity Type:Individual
Prefix:
First Name:SHELLEIGH
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLEIGH
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SHELLY FERGUSON
Mailing Address - Street 1:708 BROADWAY STE 170
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3778
Mailing Address - Country:US
Mailing Address - Phone:253-348-6542
Mailing Address - Fax:
Practice Address - Street 1:708 BROADWAY STE 170
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3778
Practice Address - Country:US
Practice Address - Phone:253-348-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
WA61327823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor