Provider Demographics
NPI:1881634772
Name:VAUGHN, THOMAS E (LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
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 1:1432 SOUTHWEST BLVD
Mailing Address - Street 2:PO BOX 1128
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109
Mailing Address - Country:US
Mailing Address - Phone:573-632-5560
Mailing Address - Fax:573-632-5875
Practice Address - Street 1:1432 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109
Practice Address - Country:US
Practice Address - Phone:573-632-5560
Practice Address - Fax:573-632-5875
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495350225Medicaid
MO149884OtherBC BS