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General NPI Number Information
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NPI Number | 1952659120
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Entity Type | Individual
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Provider Name | LAURA RUTH VAUGHN LBSW,MA
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Gender | Female
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 4405 FORTUNE LN
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City | BEAUMONT
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State | TX
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Zip | 77705-4831
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Country | US
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Telephone | 409-842-9727
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Fax | 409-840-9788
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Provider Business Mailing Address
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Address Line | P. O. BOX 41812
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City | BEAUMONT
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State | TEXAS
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Zip | 77725
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Country | UM
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Telephone | 409-842-9727
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Fax | 409-840-9788
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22408
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License Number State | TX
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