Provider Demographics
NPI:1699787630
Name:VAUGHN, KRISTIN NIEMEYER (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:NIEMEYER
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 BEECAVE WOODS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6762
Mailing Address - Country:US
Mailing Address - Phone:512-638-2951
Mailing Address - Fax:
Practice Address - Street 1:1015 BEECAVE WOODS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6762
Practice Address - Country:US
Practice Address - Phone:512-638-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32867103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical