Doctor Name: | MS. KELLY K FERGUSON |
NPI Number: | 1447302062 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMLP |
License Number: | LCP 912 |
Business Practice Address: | 212 State Street Fort Scott, KS - 667012031 |
Business Phone Number: | 6202235030 |
Business Fax Number: | 6202231650 |
Mailing Address: | 212 State Street, Po Box 704 FORT SCOTT |
State: | KS |
Postal Code: | 667012031 |
Phone Number: | 6202235030 |
Fax Number: | 6202231650 |
NPI Enumeration Date: | 01/16/2007 |
NPI Last Update Date: | 08/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | LCP 912 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |