Provider Demographics
NPI:1811939531
Name:FURGASON, MARGARET A (LPA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:FURGASON
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:PEG
Other - Middle Name:
Other - Last Name:FURGASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPA
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:
Practice Address - Street 1:300 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1492
Practice Address - Country:US
Practice Address - Phone:270-259-4652
Practice Address - Fax:270-259-6655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0558103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30605018Medicaid
11574915OtherCAQH