Provider Demographics
NPI:1427701549
Name:JENSA FERGUSON, LMHC, INC.
Entity type:Organization
Organization Name:JENSA FERGUSON, LMHC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-619-7628
Mailing Address - Street 1:23830 78TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8821
Mailing Address - Country:US
Mailing Address - Phone:206-473-7745
Mailing Address - Fax:
Practice Address - Street 1:5470 SHILSHOLE AVE NW STE 510
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4040
Practice Address - Country:US
Practice Address - Phone:206-619-7628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health