Provider Demographics
NPI:1598121568
Name:FERGESON, ERIC (LAC, LAMFT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:FERGESON
Suffix:
Gender:M
Credentials:LAC, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-4317
Mailing Address - Country:US
Mailing Address - Phone:479-719-3039
Mailing Address - Fax:
Practice Address - Street 1:927 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-4317
Practice Address - Country:US
Practice Address - Phone:479-719-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1308088101Y00000X
ARF1409013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor