Provider Demographics
NPI:1902269327
Name:FERGUSON, JENNIFER LEANN (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEANN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551566
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1566
Mailing Address - Country:US
Mailing Address - Phone:904-571-7701
Mailing Address - Fax:
Practice Address - Street 1:13500 SUTTON PARK DR S
Practice Address - Street 2:SUITE 702
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5251
Practice Address - Country:US
Practice Address - Phone:904-571-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health