Provider Demographics
NPI:1639264781
Name:VAUGHN, MARTHA WASHINGTON (MA PHD LMFT LCDC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:WASHINGTON
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MA PHD LMFT LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8284
Mailing Address - Street 2:2600 SOUTH LOOP WEST STE 220
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054
Mailing Address - Country:US
Mailing Address - Phone:713-218-7898
Mailing Address - Fax:713-218-7401
Practice Address - Street 1:2600 S LOOP WEST
Practice Address - Street 2:STE 220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-218-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0815-0694101Y00000X
TX809101YA0400X
TX2994106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist