Healthcare Provider Details

I. General information

NPI: 1255619185
Provider Name (Legal Business Name): KAREN S VAUGHN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN S WOODS PH.D.

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 06/21/2023
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 NE ANTIOCH RD STE A
KANSAS CITY MO
64119-2523
US

IV. Provider business mailing address

5140 NE ANTIOCH RD STE A
KANSAS CITY MO
64119-2523
US

V. Phone/Fax

Practice location:
  • Phone: 405-985-3838
  • Fax:
Mailing address:
  • Phone: 405-459-5545
  • Fax: 405-325-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number01179
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: