Provider Demographics
NPI:1568054641
Name:FERGUSON, DUSTIN SCOTT
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:SCOTT
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 W SHAW LN STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2775
Mailing Address - Country:US
Mailing Address - Phone:559-437-1144
Mailing Address - Fax:559-438-5004
Practice Address - Street 1:10535 ROAD 35
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8487
Practice Address - Country:US
Practice Address - Phone:559-437-1144
Practice Address - Fax:559-438-5004
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health