Organization
LAKE COUNTRY COUNSELING SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERSON DAVID FERGUSON MS, LPC (OWNER/CHILD AND FAMILY THERAPIST)
(262) 691-2982
Entity
Organization
Contact information
Practice address
325 FOREST GROVE DR, STE. 201, PEWAUKEE, WI 53072-3793
(262) 719-9470
(262) 691-2972
Mailing address
325 FOREST GROVE DR, STE. 201, PEWAUKEE, WI 53072-3793
(262) 719-9470
(262) 691-2972
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3487125
WI
Other
Enumeration date
07/02/2009
Last updated
07/02/2009
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