Basic Information
| Provider Information | |||||||||
| NPI: | 1205810678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | BA, CMHW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 822401503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075324091 | ||||||||
| FaxNumber: | 3075328409 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 822401503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075324091 | ||||||||
| FaxNumber: | 3075328409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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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 | 101Y00000X | 016A | WY | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 312368 | 01 | WY | BS OF WY | OTHER |