Provider Demographics
NPI:1669160248
Name:VAUGHN, AMANDA TAYLOR (RBT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:TAYLOR
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 WESTHARBOR DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-7222
Mailing Address - Country:US
Mailing Address - Phone:737-230-7845
Mailing Address - Fax:
Practice Address - Street 1:120 EVEREST LN
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4062
Practice Address - Country:US
Practice Address - Phone:904-297-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBCBA899100106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician