Provider Demographics
NPI:1972309714
Name:VAUGHN, TERRI L (PCLC)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:VAUGHN
Suffix:
Gender:
Credentials:PCLC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PCLC
Mailing Address - Street 1:1101 HEATHER DR APT 39
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2661
Mailing Address - Country:US
Mailing Address - Phone:406-260-1595
Mailing Address - Fax:
Practice Address - Street 1:1101 HEATHER DR APT 39
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2661
Practice Address - Country:US
Practice Address - Phone:406-260-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-64056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health