Provider Demographics
NPI:1902633712
Name:FERGUSON, SKYLER LATRICE
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:LATRICE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 E COOLEY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3966
Mailing Address - Country:US
Mailing Address - Phone:909-492-0573
Mailing Address - Fax:909-752-6182
Practice Address - Street 1:1325 E COOLEY DR STE 106
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3966
Practice Address - Country:US
Practice Address - Phone:909-492-0573
Practice Address - Fax:909-752-6182
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health