Provider Demographics
NPI:1366455040
Name:FERGUSON, PETER J (LMSW, ACSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 SUNNY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9244
Mailing Address - Country:US
Mailing Address - Phone:734-272-7145
Mailing Address - Fax:734-996-1950
Practice Address - Street 1:5331 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9520
Practice Address - Country:US
Practice Address - Phone:734-996-9111
Practice Address - Fax:734-996-1950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010811121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical