Provider Demographics
NPI:1225769540
Name:VAUGHAN, LISA GAIL (MACP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 5TH AVE NE APT 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6449
Mailing Address - Country:US
Mailing Address - Phone:602-377-1050
Mailing Address - Fax:
Practice Address - Street 1:3429 FREMONT AVE N # 316
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8811
Practice Address - Country:US
Practice Address - Phone:602-377-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health