Provider Demographics
NPI:1760630743
Name:VAUGHN, TIMOTHY (LPC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 HALLMARK DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-2212
Mailing Address - Country:US
Mailing Address - Phone:304-886-8975
Mailing Address - Fax:
Practice Address - Street 1:312 W KING ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3202
Practice Address - Country:US
Practice Address - Phone:304-886-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007378101YP2500X
WVLPC1900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV002079987OtherBLUE CROSS BLUE SHIELD