Provider Demographics
NPI:1134964083
Name:FERGUSON, MONIQUE REGAIL (PHD)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:REGAIL
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD MARVIN GRAVES ROOM NUMBER 4.210
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0435
Mailing Address - Country:US
Mailing Address - Phone:409-771-8186
Mailing Address - Fax:
Practice Address - Street 1:1200 MARKET ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0972
Practice Address - Country:US
Practice Address - Phone:409-763-5604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator