MEDICARE: DOUGLAS B VAUGHAN PHD PC

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	103TC0700X	Clinical Psychologist	PYR0374	MO

General Provider Information

NPI Number	:	1881894145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS B VAUGHAN PHD PC

Provider Business Mailing Address
First Line	:	1524 NE DEER CT
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5966
Country	:	US
Telephone Number	:	816-289-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 SW JEFFERSON ST
Second Line	:	SUITE 206
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-3988
Country	:	US
Telephone Number	:	816-554-7705
Fax Number	:	816-554-7706

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS B. VAUGHAN
Credential	:	PH.D.
Telephone Number	:	816-289-1777

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/03/2008

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