Provider Demographics
NPI:1518224088
Name:VAUGHN, ELYSE DIANA (LMFT)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:DIANA
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:DIANA
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:27789 KILDARE PL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5638
Mailing Address - Country:US
Mailing Address - Phone:951-268-4483
Mailing Address - Fax:
Practice Address - Street 1:27789 KILDARE PL
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-5638
Practice Address - Country:US
Practice Address - Phone:951-268-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist