Provider Demographics
NPI:1619258514
Name:FERGUSON, LAURIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93423-1805
Mailing Address - Country:US
Mailing Address - Phone:805-610-8694
Mailing Address - Fax:805-464-4355
Practice Address - Street 1:9700 EL CAMINO REAL
Practice Address - Street 2:SUITE #303
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5569
Practice Address - Country:US
Practice Address - Phone:805-610-8694
Practice Address - Fax:805-464-4355
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical