Provider Demographics
NPI:1104810365
Name:FERGUSON, JAMES EDWARD (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 JOLIET AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2628
Mailing Address - Country:US
Mailing Address - Phone:806-786-9654
Mailing Address - Fax:
Practice Address - Street 1:8501 JOLIET AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2628
Practice Address - Country:US
Practice Address - Phone:806-786-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25952104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX071275402Medicaid
TX071275402Medicaid