Provider Demographics
NPI:1669069183
Name:FERGUSON, JOHN W V
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:FERGUSON
Suffix:V
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 REGAL CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6638
Mailing Address - Country:US
Mailing Address - Phone:614-560-9236
Mailing Address - Fax:
Practice Address - Street 1:1492 REGAL CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-6638
Practice Address - Country:US
Practice Address - Phone:614-560-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-20-44201103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst