Provider Demographics
NPI:1104638857
Name:FERGUSON, JAIME LEA (BCBA)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:LEA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 ROSCOE FITZ RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3440
Mailing Address - Country:US
Mailing Address - Phone:423-262-3160
Mailing Address - Fax:
Practice Address - Street 1:268 ROSCOE FITZ RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-3440
Practice Address - Country:US
Practice Address - Phone:423-262-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1739103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst