Provider Demographics
NPI:1932589413
Name:FERGUSON, BETHANY MORGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MORGAN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10465 MELODY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4119
Mailing Address - Country:US
Mailing Address - Phone:970-578-0103
Mailing Address - Fax:
Practice Address - Street 1:4851 INDEPENDENCE ST STE 100
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-425-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09925286OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES