Provider Demographics
NPI:1265910848
Name:FERGUSON, TERRIC W (BS)
Entity type:Individual
Prefix:MRS
First Name:TERRIC
Middle Name:W
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:LA
Mailing Address - Zip Code:71075-9700
Mailing Address - Country:US
Mailing Address - Phone:318-560-0505
Mailing Address - Fax:866-307-9980
Practice Address - Street 1:2210 LINE AVE STE 207
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-675-1112
Practice Address - Fax:866-307-9980
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-05
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator