MEDICARE: NUR BANU IBAOGLU VAUGHN MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4746	GA

General Provider Information

NPI Number	:	1396937413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NUR BANU IBAOGLU VAUGHN MA, LPC

Provider Business Mailing Address
First Line	:	4015 S COBB DR SE STE 100
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6315
Country	:	US
Telephone Number	:	678-318-3616
Fax Number	:	678-318-3616

Provider Business Practice Location Address
First Line	:	4015 S COBB DR SE STE 100
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6315
Country	:	US
Telephone Number	:	678-318-3616
Fax Number	:	678-318-3616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	06/10/2009

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