Individual
ROBERT FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.T.S.
Contact information
Practice address
1828 CRANDELL, HEBER, AZ 85928-5606
(907) 347-8619
Mailing address
PO BOX 1064, OVERGAARD, AZ 85933-1064
(907) 347-8619
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11866128
AZ
253J00000X
Foster Care Agency
11866128
AZ
385HR2055X
Child Mental Illness Respite Care
11866128
AZ
Other
Enumeration date
10/20/2022
Last updated
04/24/2023
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