Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 21805 | TX |
Y | 103T00000X | Psychologist | 21805 | TX |
N | 103TM1800X | Intellectual & Developmental Disabilities | 21805 | TX |
NPI | 1003977679 |
---|---|
Provider Name | Helen B Ferguson |
First Address | Fort Worth, TX 76107-7277 |
Second Address | Fort Worth, TX 76107-7277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 26/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150897001 | (05) | TX |
150897004 | (05) | TX |
P55906 | (02) | TX |