Provider Demographics
NPI:1518224088
Name:VAUGHN, ELYSE DIANA
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:DIANA
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:DIANA
Other - Last Name:VAUGHN-WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:4025 W 226TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2340
Mailing Address - Country:US
Mailing Address - Phone:310-373-4556
Mailing Address - Fax:
Practice Address - Street 1:4025 W 226TH ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2340
Practice Address - Country:US
Practice Address - Phone:310-373-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist