Provider Demographics
NPI:1336700145
Name:FERGUSON, LAURA DUVALL (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DUVALL
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9380 S WATSON GULCH RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-9438
Mailing Address - Country:US
Mailing Address - Phone:720-318-1373
Mailing Address - Fax:
Practice Address - Street 1:6949 HIGHWAY 73 STE MW-3
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-6295
Practice Address - Country:US
Practice Address - Phone:720-318-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099258011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty