Provider Demographics
NPI:1265559165
Name:FERGUSON, L. CHRIS (MFC #49110)
Entity type:Individual
Prefix:
First Name:L.
Middle Name:CHRIS
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MFC #49110
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CHRISTINE
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFC #49110
Mailing Address - Street 1:PO BOX 3312
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95063-3312
Mailing Address - Country:US
Mailing Address - Phone:805-405-5516
Mailing Address - Fax:
Practice Address - Street 1:1114 E CLIFF DR
Practice Address - Street 2:#1
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-3759
Practice Address - Country:US
Practice Address - Phone:805-405-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #49110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist