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NPI Code Detail

MEDICARE: KRISTINA MARIE VAUGHAN LCSW

MEDICARE: KRISTINA MARIE VAUGHAN LCSW
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
11041C0700XClinical Social Worker65945TX
21041C0700XClinical Social Worker149.027899IL

General Provider Information

NPI Number : 1841043858
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA MARIE VAUGHAN LCSW
Provider Business Mailing Address
First Line : 3223 S LOOP 289
Second Line : SUITE 600, PRIVATE OFFICE 630
City : LUBBOCK
State : TX
Zip : 79423-1337
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 22001 SOUTHWEST FWY STE 125
Second Line :
City : RICHMOND
State : TX
Zip : 77469-7118
Country : US
Telephone Number : 844-824-8775
Fax Number : 281-648-2200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2024
Last Update Date : 01/14/2026

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