Doctor Name: | MRS. BRANDI LYNN FERGUSON |
NPI Number: | 1336267202 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | B.A. B.H.R.S. C.M.-A |
License Number: | |
Business Practice Address: | 2000 E Lincoln Rd Box 1527 Idabel, OK - 747457353 |
Business Phone Number: | 5802866639 |
Business Fax Number: | 5802865206 |
Mailing Address: | 2000 E Lincoln Rd, P.o. Box 1527 IDABEL |
State: | OK |
Postal Code: | 747457353 |
Phone Number: | 5802866639 |
Fax Number: | 5802865206 |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |