Provider Demographics
NPI:1336402643
Name:FERGUSON, LEE ROBERT (LICSW)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:ROBERT
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LICSW
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 5582
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99302-5501
Mailing Address - Country:US
Mailing Address - Phone:509-438-7139
Mailing Address - Fax:
Practice Address - Street 1:660 GEORGE WASHINGTON WAY STE D
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4246
Practice Address - Country:US
Practice Address - Phone:509-438-7139
Practice Address - Fax:509-713-7015
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALW60533326104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker