Provider Demographics
NPI:1356680235
Name:FERGUSON, TRUDY MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TRUDY
Middle Name:MARIE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 SE TECH CENTER PL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5528
Mailing Address - Country:US
Mailing Address - Phone:408-838-5517
Mailing Address - Fax:
Practice Address - Street 1:1499 SE TECH CENTER PL
Practice Address - Street 2:SUITE 205
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5528
Practice Address - Country:US
Practice Address - Phone:408-838-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT53396106H00000X
WALF60539019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist