Provider Demographics
NPI:1063287563
Name:VAUGHT, SHANNON R (MA, CAADC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:MA, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6574 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-4209
Mailing Address - Country:US
Mailing Address - Phone:484-241-1570
Mailing Address - Fax:
Practice Address - Street 1:6574 CHURCH RD
Practice Address - Street 2:
Practice Address - City:SLATINGTON
Practice Address - State:PA
Practice Address - Zip Code:18080-4209
Practice Address - Country:US
Practice Address - Phone:484-241-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor