1548415664 NPI number — SHAYLA SIMON FERGUSON MA,CCC-A

Table of content: SHAYLA SIMON FERGUSON MA,CCC-A (NPI 1548415664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548415664 NPI number — SHAYLA SIMON FERGUSON MA,CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
SHAYLA
Provider Middle Name:
SIMON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA,CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMON
Provider Other First Name:
SHAYLA
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548415664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9494 SOUTHWEST FREEWAY
Provider Second Line Business Mailing Address:
SUITE 850
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-649-7000
Provider Business Mailing Address Fax Number:
713-484-6649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7789 SOUTHWEST FWY STE 470
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-649-7000
Provider Business Practice Location Address Fax Number:
713-995-4720
Provider Enumeration Date:
11/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231HA2400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 51593 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)