Provider Demographics
NPI:1467783365
Name:VAUGHN, LOUISE ANN (CMHC)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:ANN
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DUCHESNE
Mailing Address - State:UT
Mailing Address - Zip Code:84021-0318
Mailing Address - Country:US
Mailing Address - Phone:435-738-2040
Mailing Address - Fax:
Practice Address - Street 1:382 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:DUCHESNE
Practice Address - State:UT
Practice Address - Zip Code:84021-0318
Practice Address - Country:US
Practice Address - Phone:435-738-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10071409-6004101YM0800X
GALPC004979101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional