Provider Demographics
NPI:1508192972
Name:VAUGHN, TRACY KEVIN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:KEVIN
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7331
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-7331
Mailing Address - Country:US
Mailing Address - Phone:317-590-0405
Mailing Address - Fax:
Practice Address - Street 1:25 S EWING ST STE 520
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5753
Practice Address - Country:US
Practice Address - Phone:317-590-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-1457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health