1932146404 NPI number — MRS. MYRNA B. VAUGHAN LPC

Table of content: MRS. MYRNA B. VAUGHAN LPC (NPI 1932146404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932146404 NPI number — MRS. MYRNA B. VAUGHAN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUGHAN
Provider First Name:
MYRNA
Provider Middle Name:
B.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932146404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 SW JEFFERSON ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64063-3988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-554-7705
Provider Business Mailing Address Fax Number:
816-554-7706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 SW JEFFERSON ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64063-3988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-554-7705
Provider Business Practice Location Address Fax Number:
816-554-7706
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  002366 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MANAGED HEALTH CARE . This is a "PROVIDER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: ST. LUKE'S HEALTHCAR . This is a "PROVIDER/EAP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: UNITED BEHAVIORAL HE . This is a "PROVIDER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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