Provider Demographics
NPI:1952659120
Name:VAUGHN, LAURA RUTH (LBSW,MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTH
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LBSW,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 41812
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TEXAS
Mailing Address - Zip Code:77725
Mailing Address - Country:UM
Mailing Address - Phone:409-842-9727
Mailing Address - Fax:409-840-9788
Practice Address - Street 1:4405 FORTUNE LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-4831
Practice Address - Country:US
Practice Address - Phone:409-842-9727
Practice Address - Fax:409-840-9788
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22408104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker