Provider Demographics
NPI:1184483224
Name:VAUGHN-VALENCIA, ABEL
Entity type:Individual
Prefix:MR
First Name:ABEL
Middle Name:
Last Name:VAUGHN-VALENCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ABEL
Other - Middle Name:
Other - Last Name:VALENCIA
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13212 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6169
Mailing Address - Country:US
Mailing Address - Phone:512-422-1651
Mailing Address - Fax:
Practice Address - Street 1:6051 N BROOKLINE AVE STE 112
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4286
Practice Address - Country:US
Practice Address - Phone:405-810-0054
Practice Address - Fax:405-810-8977
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPCCANDIDATE12080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional