Provider Demographics
NPI:1659332393
Name:FERGUSON, DAVID ROY (LCPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROY
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 SLATE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BIRD
Mailing Address - State:ID
Mailing Address - Zip Code:83554-5040
Mailing Address - Country:US
Mailing Address - Phone:208-484-4609
Mailing Address - Fax:208-467-4684
Practice Address - Street 1:1102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RIGGINS
Practice Address - State:ID
Practice Address - Zip Code:83549-9700
Practice Address - Country:US
Practice Address - Phone:208-484-4609
Practice Address - Fax:208-345-3502
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional