Healthcare Provider Details

I. General information

NPI: 1043829179
Provider Name (Legal Business Name): RICKY LEE VAUGHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 EDWARDS
MERKEL TX
79536-3803
US

IV. Provider business mailing address

1749 PINE ST
ABILENE TX
79601-3043
US

V. Phone/Fax

Practice location:
  • Phone: 325-928-0014
  • Fax: 325-928-1175
Mailing address:
  • Phone: 325-696-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number80145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: