Basic Information
| Provider Information | |||||||||
| NPI: | 1013133529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | TAMI | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 286 ALFRED ST | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484579154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102322766 | ||||||||
| FaxNumber: | 8102322782 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 W WATER ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485035627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102322766 | ||||||||
| FaxNumber: | 8102322782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6802064353 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.