Healthcare Provider Details

I. General information

NPI: 1821925215
Provider Name (Legal Business Name): VANESSA L VAUGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 E 20TH ST
JOPLIN MO
64804-1037
US

IV. Provider business mailing address

2501 E 20TH ST
JOPLIN MO
64804-1037
US

V. Phone/Fax

Practice location:
  • Phone: 417-437-0854
  • Fax:
Mailing address:
  • Phone: 417-437-0854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2026017764
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: