Provider Demographics
NPI:1720408503
Name:VAUGHAN, TRACY (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 RAY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9547
Mailing Address - Country:US
Mailing Address - Phone:304-412-3708
Mailing Address - Fax:
Practice Address - Street 1:38 RAY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9547
Practice Address - Country:US
Practice Address - Phone:304-412-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1-13-12907103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst