Provider Demographics
NPI:1609408103
Name:FERGUSON, REBECCA AUTUMN (MS, LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:AUTUMN
Last Name:FERGUSON
Suffix:
Gender:
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 W HUNTSVILLE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2600
Mailing Address - Country:US
Mailing Address - Phone:479-334-7293
Mailing Address - Fax:479-358-1476
Practice Address - Street 1:2112 W HUNTSVILLE AVE STE B
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2600
Practice Address - Country:US
Practice Address - Phone:479-334-7293
Practice Address - Fax:479-358-1476
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101YM0800X
ARP2109004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1992484430OtherNPI2