1417301359 NPI number — MR. JOHN THOMAS FERGUSON JR. LMFTA

Table of content: MR. JOHN THOMAS FERGUSON JR. LMFTA (NPI 1417301359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417301359 NPI number — MR. JOHN THOMAS FERGUSON JR. LMFTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
JOHN
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
LMFTA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERGUSON
Provider Other First Name:
J.T.
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
LMFTA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417301359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3209 W SMITH VALLEY ROAD
Provider Second Line Business Mailing Address:
#225
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-884-5012
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3209 W SMITH VALLEY ROAD
Provider Second Line Business Practice Location Address:
#225
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-884-5012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  85000220A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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