Healthcare Provider Details

I. General information

NPI: 1477684553
Provider Name (Legal Business Name): LARITHA VAUGHN CAS II, MA, MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14020 ORIZABA AVE 4
PARAMOUNT CA
90723-6124
US

IV. Provider business mailing address

PO BOX 51
PARAMOUNT CA
90723-0051
US

V. Phone/Fax

Practice location:
  • Phone: 323-419-7384
  • Fax:
Mailing address:
  • Phone: 323-419-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: