Provider Demographics
NPI:1205352770
Name:FERGUSON, JESSICA RACHEEL (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RACHEEL
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2684 GARDENDALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-5627
Mailing Address - Country:US
Mailing Address - Phone:817-458-6838
Mailing Address - Fax:
Practice Address - Street 1:2684 GARDENDALE DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120
Practice Address - Country:US
Practice Address - Phone:817-458-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional