Provider Demographics
NPI:1417301359
Name:FERGUSON, JOHN THOMAS JR (LMFTA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:FERGUSON
Suffix:JR
Gender:M
Credentials:LMFTA
Other - Prefix:MR
Other - First Name:J.T.
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:LMFTA
Mailing Address - Street 1:3209 W SMITH VALLEY ROAD
Mailing Address - Street 2:#225
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46142
Mailing Address - Country:US
Mailing Address - Phone:317-884-5012
Mailing Address - Fax:
Practice Address - Street 1:3209 W SMITH VALLEY ROAD
Practice Address - Street 2:#225
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46142
Practice Address - Country:US
Practice Address - Phone:317-884-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000220A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist