Provider Demographics
NPI:1023299484
Name:GREEN FERGUSON, JOAN D (MS ED, LMHC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:D
Last Name:GREEN FERGUSON
Suffix:
Gender:F
Credentials:MS ED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-0123
Mailing Address - Country:US
Mailing Address - Phone:206-331-6608
Mailing Address - Fax:
Practice Address - Street 1:38122 307TH AVE SE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-9643
Practice Address - Country:US
Practice Address - Phone:206-331-6608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60024103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist