MEDICARE: MRS. MADELINE MARIE VAUGHN LCSW

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	104100000X	Social Worker	61059	TX

General Provider Information

NPI Number	:	1891179446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADELINE MARIE VAUGHN LCSW

Provider Business Mailing Address
First Line	:	7500 SAN FELIPE SUITE 480
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-4446
Country	:	US
Telephone Number	:	713-364-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 SAN FELIPE SUITE 480
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-4446
Country	:	US
Telephone Number	:	713-364-6350
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	06/25/2023

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