Provider Demographics
NPI:1205849163
Name:VAUGHN, TAMMY M (LPC)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:M
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3378 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561
Mailing Address - Country:US
Mailing Address - Phone:251-943-7323
Mailing Address - Fax:251-973-8223
Practice Address - Street 1:21441 HWY 98 E
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-943-7323
Practice Address - Fax:251-973-8223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
AL3883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200370310AMedicaid