Provider Demographics
NPI:1477336683
Name:VAUGHN, MATTHEW S (MFT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9948 DOTSON ST SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7728
Mailing Address - Country:US
Mailing Address - Phone:360-870-3362
Mailing Address - Fax:
Practice Address - Street 1:9948 DOTSON ST SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7728
Practice Address - Country:US
Practice Address - Phone:360-870-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist