Provider Demographics
NPI:1669654505
Name:FERGUSON, JENNIFER HORTENSE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:HORTENSE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ARMSTRONG
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT, CDP
Mailing Address - Street 1:9124 GRAVELLY LAKE DR SW
Mailing Address - Street 2:LAKES PLAZA SUITE 101
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3198
Mailing Address - Country:US
Mailing Address - Phone:253-503-0236
Mailing Address - Fax:253-503-0982
Practice Address - Street 1:9124 GRAVELLY LAKE DR SW
Practice Address - Street 2:LAKES PLAZA SUITE 101
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3198
Practice Address - Country:US
Practice Address - Phone:253-503-0236
Practice Address - Fax:253-503-0982
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACPOOOO5222101YA0400X
WAMG60171687106H00000X
WALF60079410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA331-8907Medicaid
WAVAD000Medicare UPIN