Healthcare Provider Details

I. General information

NPI: 1821705013
Provider Name (Legal Business Name): MRS. BEVERLY FAYE VAUGHN-TRAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 OHIO RIVER RD
WHEELERSBURG OH
45694-1714
US

IV. Provider business mailing address

8308 OHIO RIVER RD
WHEELERSBURG OH
45694-1714
US

V. Phone/Fax

Practice location:
  • Phone: 740-529-1201
  • Fax:
Mailing address:
  • Phone: 740-529-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.190585
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: