Individual
MR. KELLY WAYNE FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LMFT
Contact information
Practice address
1916 UNIVERSITY AVE, OXFORD, MS 38655-4114
(662) 281-1306
(662) 281-1326
Mailing address
60 DOGWOOD CV, PONTOTOC, MS 38863-7627
(386) 214-4351
(662) 844-1757
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
MT0897
FL
Other
Enumeration date
05/21/2012
Last updated
09/06/2013
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