Provider Demographics
NPI:1154318806
Name:VAUGHT, PAMELA M (EDD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 RIVERDELL FARMS RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331
Mailing Address - Country:US
Mailing Address - Phone:616-897-3059
Mailing Address - Fax:
Practice Address - Street 1:1256 WALKER AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504
Practice Address - Country:US
Practice Address - Phone:616-235-2910
Practice Address - Fax:616-235-1436
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07010001257101YP2500X
MI6401010056101YP2500X
VA0717000110106H00000X
MI4101006334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist