Provider Demographics
NPI:1851834477
Name:FERGUSON, TAWNI MARIE (QMHA)
Entity Type:Individual
Prefix:
First Name:TAWNI
Middle Name:MARIE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 NW JETTY AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-4342
Mailing Address - Country:US
Mailing Address - Phone:801-889-9822
Mailing Address - Fax:
Practice Address - Street 1:4422 NE DEVILS LAKE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5000
Practice Address - Country:US
Practice Address - Phone:541-265-4196
Practice Address - Fax:541-994-1882
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health