Provider Demographics
NPI:1073710331
Name:VAUGHAN, RYAN BRADLEY (QMHA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:BRADLEY
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60933 CLEARMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2794
Mailing Address - Country:US
Mailing Address - Phone:541-350-1071
Mailing Address - Fax:
Practice Address - Street 1:1059 NW MADRAS HWY
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1416
Practice Address - Country:US
Practice Address - Phone:541-323-5330
Practice Address - Fax:541-447-1121
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health