Provider Demographics
NPI:1346849759
Name:VAUGHAN, SHELIE RANAE (BACHELOR PHYCOLOGY)
Entity Type:Individual
Prefix:
First Name:SHELIE
Middle Name:RANAE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:BACHELOR PHYCOLOGY
Other - Prefix:
Other - First Name:SHELIE
Other - Middle Name:
Other - Last Name:LASSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1271
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-1271
Mailing Address - Country:US
Mailing Address - Phone:918-675-4100
Mailing Address - Fax:
Practice Address - Street 1:130 W STEVE OWENS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-7629
Practice Address - Country:US
Practice Address - Phone:918-675-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)