Provider Demographics
NPI:1427855196
Name:VAUGHAN, MORGAN (LAC)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2803
Mailing Address - Country:US
Mailing Address - Phone:479-964-2011
Mailing Address - Fax:
Practice Address - Street 1:1310 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2803
Practice Address - Country:US
Practice Address - Phone:479-964-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2502023101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor