Provider Demographics
NPI:1205951837
Name:VAUGHAN, MARY ELIZABETH (LMHC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 GAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-6657
Mailing Address - Country:US
Mailing Address - Phone:850-247-8354
Mailing Address - Fax:
Practice Address - Street 1:1000 W THARPE ST STE 9
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5300
Practice Address - Country:US
Practice Address - Phone:813-290-8560
Practice Address - Fax:850-290-7442
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6981101YP2500X, 101YM0800X
SC3545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ093POtherBLUE CROSS BLUE SHIELD FLORIDA