Provider Demographics
NPI:1447352265
Name:FERGUSON, PEGGY LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:LYNN
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 1:116 W 7TH AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4064
Mailing Address - Country:US
Mailing Address - Phone:405-707-9600
Mailing Address - Fax:405-707-9601
Practice Address - Street 1:116 W 7TH AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4064
Practice Address - Country:US
Practice Address - Phone:405-707-9600
Practice Address - Fax:405-707-9601
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK237101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)