Individual
MATT FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
925 E 12TH ST, JOPLIN, MO 64801-4977
(417) 680-4651
Mailing address
925 E 12TH ST, JOPLIN, MO 64801-4977
(417) 680-4651
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
MO
Other
Enumeration date
04/23/2020
Last updated
12/22/2025
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