Provider Demographics
NPI:1770306888
Name:VAUGHAN, CRISTEN LORRAINE (ACLC)
Entity type:Individual
Prefix:
First Name:CRISTEN
Middle Name:LORRAINE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:ACLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2319
Mailing Address - Country:US
Mailing Address - Phone:406-407-3069
Mailing Address - Fax:
Practice Address - Street 1:309 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2319
Practice Address - Country:US
Practice Address - Phone:406-407-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-72970101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)