Provider Demographics
NPI:1790433407
Name:FERGUSON, XAVIERA
Entity Type:Individual
Prefix:
First Name:XAVIERA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N CENTRAL AVE APT 1225
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2777
Mailing Address - Country:US
Mailing Address - Phone:775-351-4926
Mailing Address - Fax:
Practice Address - Street 1:800 N CENTRAL AVE APT 1225
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2777
Practice Address - Country:US
Practice Address - Phone:775-351-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000OtherNONE