Provider Demographics
NPI:1164873584
Name:VAUGHN, ANNIE HART (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:HART
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:RICHMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 E RIVER DR STE 330
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5761
Mailing Address - Country:US
Mailing Address - Phone:563-424-0136
Mailing Address - Fax:
Practice Address - Street 1:1225 E RIVER DR STE 330
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5761
Practice Address - Country:US
Practice Address - Phone:563-424-0136
Practice Address - Fax:563-526-4116
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health