Provider Demographics
NPI:1932146404
Name:VAUGHAN, MYRNA B (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:B
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SW JEFFERSON ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-3988
Mailing Address - Country:US
Mailing Address - Phone:816-554-7705
Mailing Address - Fax:816-554-7706
Practice Address - Street 1:600 SW JEFFERSON ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-3988
Practice Address - Country:US
Practice Address - Phone:816-554-7705
Practice Address - Fax:816-554-7706
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMANAGED HEALTH CAREOtherPROVIDER
MOST. LUKE'S HEALTHCAROtherPROVIDER/EAP
MOUNITED BEHAVIORAL HEOtherPROVIDER