Provider Demographics
NPI:1093950610
Name:VAUGHT, ERVIN LEWIS (MSSW)
Entity Type:Individual
Prefix:MR
First Name:ERVIN
Middle Name:LEWIS
Last Name:VAUGHT
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1914
Mailing Address - Country:US
Mailing Address - Phone:479-582-7152
Mailing Address - Fax:479-251-1823
Practice Address - Street 1:1416 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1914
Practice Address - Country:US
Practice Address - Phone:479-582-7152
Practice Address - Fax:479-251-1823
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2202M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker