Provider Demographics
NPI:1336534981
Name:LESLIE FERGUSON , PLLC
Entity Type:Organization
Organization Name:LESLIE FERGUSON , PLLC
Other - Org Name:MINDFUL CHOICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-965-9474
Mailing Address - Street 1:420A W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1836
Mailing Address - Country:US
Mailing Address - Phone:859-965-9474
Mailing Address - Fax:
Practice Address - Street 1:420A W WALNUT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1836
Practice Address - Country:US
Practice Address - Phone:859-965-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health