Basic Information
| Provider Information | |||||||||
| NPI: | 1104909811 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL-FERGUSON | ||||||||
| FirstName: | TRICIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 WHITNEY AVE | ||||||||
| Address2: | 604 | ||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043620504 | ||||||||
| FaxNumber: | 5044634086 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 WHITNEY AVE | ||||||||
| Address2: | SUITE 128B | ||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700562558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049949193 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 06/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 2203783236 | LA | N | Other Service Providers | Case Manager/Care Coordinator | 101Y00000X | 3134 | LA | Y | Behavioral Health & Social Service Providers | Counselor | 106H00000X | 1029 | LA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.