Provider Demographics
NPI:1619785953
Name:CASEY FERGUSON LPC INC
Entity type:Organization
Organization Name:CASEY FERGUSON LPC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-505-2986
Mailing Address - Street 1:6580 VALLEY CENTER DR STE 169
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-5694
Mailing Address - Country:US
Mailing Address - Phone:540-505-2986
Mailing Address - Fax:540-380-0079
Practice Address - Street 1:6580 VALLEY CENTER DR STE 169
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-5694
Practice Address - Country:US
Practice Address - Phone:540-505-2986
Practice Address - Fax:540-380-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty