Provider Demographics
NPI:1255585154
Name:FERGUSON, JOSEPH GLENN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GLENN
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 WILDERNESS ARROYO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5922
Mailing Address - Country:US
Mailing Address - Phone:505-913-7159
Mailing Address - Fax:
Practice Address - Street 1:2232 WILDERNESS ARROYO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5922
Practice Address - Country:US
Practice Address - Phone:505-913-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22260103TC0700X
NM1401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical