Provider Demographics
NPI:1275814311
Name:VAUGHAN, ANNA-THERESE (MA)
Entity Type:Individual
Prefix:
First Name:ANNA-THERESE
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 E 00 NS
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-6631
Mailing Address - Country:US
Mailing Address - Phone:765-236-1964
Mailing Address - Fax:765-236-1960
Practice Address - Street 1:2738 E 00 NS
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6631
Practice Address - Country:US
Practice Address - Phone:765-236-1964
Practice Address - Fax:765-236-1960
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health