Provider Demographics
NPI:1265749154
Name:FERGUSON, LORNETA HALL (LCSW)
Entity type:Individual
Prefix:
First Name:LORNETA
Middle Name:HALL
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 790099
Mailing Address - Street 2:633 EAST HIGHWAY 9
Mailing Address - City:VIRGIN
Mailing Address - State:UT
Mailing Address - Zip Code:84779
Mailing Address - Country:US
Mailing Address - Phone:435-635-5260
Mailing Address - Fax:435-635-5327
Practice Address - Street 1:633 E HWY 9
Practice Address - Street 2:
Practice Address - City:VIRGIN
Practice Address - State:UT
Practice Address - Zip Code:84779
Practice Address - Country:US
Practice Address - Phone:435-635-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5655807-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical