Provider Demographics
NPI:1437287950
Name:FERGUSON, MELVIN DOUGLAS (LSPE)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:DOUGLAS
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LSPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2650
Mailing Address - Country:US
Mailing Address - Phone:615-460-4100
Mailing Address - Fax:615-460-4561
Practice Address - Street 1:1101 6TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2650
Practice Address - Country:US
Practice Address - Phone:615-460-4100
Practice Address - Fax:615-460-4561
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional