Healthcare Provider Details

I. General information

NPI: 1679467856
Provider Name (Legal Business Name): AMY VAUGHN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 GOVERNMENT BLVD
MOBILE AL
36693-4813
US

IV. Provider business mailing address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

V. Phone/Fax

Practice location:
  • Phone: 251-666-2569
  • Fax: 251-277-8632
Mailing address:
  • Phone: 251-450-5916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberL682
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: