Provider Demographics
NPI:1992418321
Name:VAUGHAN, SUZETTE ELIZABETH (LMFT)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:ELIZABETH
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 MOORPARK WAY APT 105
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2471
Mailing Address - Country:US
Mailing Address - Phone:661-877-6210
Mailing Address - Fax:
Practice Address - Street 1:444 N LARCHMONT BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3030
Practice Address - Country:US
Practice Address - Phone:818-810-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95042106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist