Provider Demographics
NPI:1295179331
Name:VAUGHN, STACY LYNN (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2946
Mailing Address - Country:US
Mailing Address - Phone:402-813-0501
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 210
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2946
Practice Address - Country:US
Practice Address - Phone:402-813-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE954101YA0400X
NE1318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)