Healthcare Provider Details

I. General information

NPI: 1871272328
Provider Name (Legal Business Name): ELIZABETH VAUGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 10TH AVE S
GREAT FALLS MT
59405-3451
US

IV. Provider business mailing address

1703 FOX FARM RD
GREAT FALLS MT
59404-3323
US

V. Phone/Fax

Practice location:
  • Phone: 877-393-6232
  • Fax:
Mailing address:
  • Phone: 406-781-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-80183
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: