Provider Demographics
NPI:1922308295
Name:FERGUSON, LINDSAY ERVIN JR (MS, MFT)
Entity Type:Individual
Prefix:MR
First Name:LINDSAY
Middle Name:ERVIN
Last Name:FERGUSON
Suffix:JR
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 A ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3123
Mailing Address - Country:US
Mailing Address - Phone:415-258-4515
Mailing Address - Fax:415-236-1830
Practice Address - Street 1:1005 A ST
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3123
Practice Address - Country:US
Practice Address - Phone:415-258-4515
Practice Address - Fax:415-236-1830
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist