Individual
STEPHEN RANDALL FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
2831 FORT MISSOULA ROAD SUITE 201, MISSOULA, MT 59804
(406) 544-4510
Mailing address
P.O. BOX 5443, MISSOULA, MT 59806
(406) 544-4510
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
BBH-LAC-LIC-43978
MT
101YM0800X
Mental Health Counselor
BBH-SWLC-LIC-44257
MT
Other
Enumeration date
01/31/2021
Last updated
01/31/2021
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