Provider Demographics
NPI:1174038293
Name:VAUGHN MACK, STEFANY (LPCC-S)
Entity Type:Individual
Prefix:
First Name:STEFANY
Middle Name:
Last Name:VAUGHN MACK
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2903
Mailing Address - Country:US
Mailing Address - Phone:270-479-8900
Mailing Address - Fax:877-308-1668
Practice Address - Street 1:115 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2903
Practice Address - Country:US
Practice Address - Phone:270-479-8900
Practice Address - Fax:877-308-1668
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100496490Medicaid