Provider Demographics
NPI:1326254996
Name:VAUGHAN, GAYLE MAUREEN (MA, LSC)
Entity Type:Individual
Prefix:MISS
First Name:GAYLE
Middle Name:MAUREEN
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MA, LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 RIDGE DR
Mailing Address - Street 2:#14
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5627
Mailing Address - Country:US
Mailing Address - Phone:612-720-3614
Mailing Address - Fax:
Practice Address - Street 1:2240 RIDGE DR
Practice Address - Street 2:#14
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5627
Practice Address - Country:US
Practice Address - Phone:612-720-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN404390101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool