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NPI Code Detail

MEDICARE: VAUGHNA MARIE KYSTAL PELLICCIA LPCC

MEDICARE: VAUGHNA MARIE KYSTAL PELLICCIA LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPP.0021412CO

General Provider Information

NPI Number : 1235694415
Entity Type Code : Individual
Provider Name (Legal Business Name) : VAUGHNA MARIE KYSTAL PELLICCIA LPCC
Provider Business Mailing Address
First Line : 2116 HOLLOW BROOK DR STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-1443
Country : US
Telephone Number : 719-249-0984
Fax Number :
Provider Business Practice Location Address
First Line : 2116 HOLLOW BROOK DR STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-1443
Country : US
Telephone Number : 719-249-0984
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2019
Last Update Date : 02/21/2024

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Directions to “ VAUGHNA MARIE KYSTAL PELLICCIA LPCC” Practice Location

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