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General NPI Number Information
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NPI Number | 1285873992
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Entity Type | Organization
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Legal Business Name | VAUGHAN PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 3212 SITE TO SEE
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City | EUSTIS
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State | FL
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Zip | 32726-2344
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Country | US
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Telephone | 352-357-5055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1881
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City | MOUNT DORA
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State | FL
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Zip | 32756-1881
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Country | US
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Telephone | 352-457-5055
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. NADINE VAUGHAN
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Credential |
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Telephone | 352-457-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | PY6663
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License Number State | FL
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