Jefferson David Ferguson, LPC
Counselor, Professional in Pewaukee, WI. Individual provider (NPI-1).
NPI number1164533147
StatusActive
Last updated in NPPESSep 10, 2024
Details
- NPI
- 1164533147
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jefferson David Ferguson
- Credential
- LPC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 31, 2006
- Certification date
- Sep 10, 2024
- Last updated
- Sep 10, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | 4885-125 | WI | Yes |
Practice location
353 Forest Grove Dr Ste 100Pewaukee, WI 53072-3765
Phone 262-719-9470 · Fax 262-691-2972
Mailing address
353 Forest Grove Dr Ste 100Pewaukee, WI 53072-3765
Phone 262-719-9470 · Fax 262-691-2972
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