Provider Demographics
NPI:1740013663
Name:FERGUSON, KENNA H
Entity type:Individual
Prefix:
First Name:KENNA
Middle Name:H
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 W LAMBERTH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5181
Mailing Address - Country:US
Mailing Address - Phone:903-200-1505
Mailing Address - Fax:
Practice Address - Street 1:2612 W LAMBERTH RD STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5181
Practice Address - Country:US
Practice Address - Phone:903-200-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician