MEDICARE: FALLON ELLEN VAUGHT MA, LMHC

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
1	101YM0800X	Mental Health Counselor	MHC01955	RI

General Provider Information

NPI Number	:	1316506157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FALLON ELLEN VAUGHT MA, LMHC

Provider Business Mailing Address
First Line	:	88 JANET DR
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-7424
Country	:	US
Telephone Number	:	401-384-0674
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 TOLL GATE RD STE 206
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-4351
Country	:	US
Telephone Number	:	401-384-0674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2019
Last Update Date	:	04/20/2026

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