MEDICARE: ALEXANDRA NICOLE VAUGHN

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	LPC-23689	AZ
2	101YM0800X	Mental Health Counselor	3071362	ID
3	101YM0800X	Mental Health Counselor	LH61619257	WA
4	101YM0800X	Mental Health Counselor	TPMC5257	FL
5	101YM0800X	Mental Health Counselor	CP5515	NV

General Provider Information

NPI Number	:	1649753591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA NICOLE VAUGHN

Provider Business Mailing Address
First Line	:	7121 W CRAIG RD STE 113
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7121 W CRAIG RD STE 113
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6038
Country	:	US
Telephone Number	:	833-378-2162
Fax Number	:

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	05/16/2025

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Directions to “ ALEXANDRA NICOLE VAUGHN ” Practice Location

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