Provider Demographics
NPI:1295912327
Name:FERGUSON, GUY R (LPC)
Entity type:Individual
Prefix:MR
First Name:GUY
Middle Name:R
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-0634
Mailing Address - Country:US
Mailing Address - Phone:908-236-0303
Mailing Address - Fax:
Practice Address - Street 1:1111 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-4213
Practice Address - Country:US
Practice Address - Phone:908-236-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00247500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01663659OtherMAGELLAN PIN