Healthcare Provider Details

I. General information

NPI: 1588008437
Provider Name (Legal Business Name): SARA JEAN VAUGHN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA VAUGHN LPC

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SOUTH 2ND STREET SUITE A
CLINTON MO
64735
US

IV. Provider business mailing address

210 SOUTH 2ND STREET SUITE A
CLINTON MO
64735
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-2394
  • Fax: 660-383-1650
Mailing address:
  • Phone: 660-885-2394
  • Fax: 660-383-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013011416
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2023048396
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: