Provider Demographics
NPI:1013318062
Name:FERGUSON, DENISE LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LOUISE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:L
Other - Last Name:MOON-FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2622 PICO AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5000
Mailing Address - Country:US
Mailing Address - Phone:831-206-1992
Mailing Address - Fax:
Practice Address - Street 1:24511 W JAYNE AVE
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9503
Practice Address - Country:US
Practice Address - Phone:599-934-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34815103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist