Provider Demographics
NPI:1326684978
Name:ANNIE VAUGHN COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:ANNIE VAUGHN COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:563-424-0136
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61266-0850
Mailing Address - Country:US
Mailing Address - Phone:309-762-9711
Mailing Address - Fax:309-764-0553
Practice Address - Street 1:4620 E 53RD ST STE 258
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3627
Practice Address - Country:US
Practice Address - Phone:563-424-0136
Practice Address - Fax:563-355-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty