Provider Demographics
NPI:1881894145
Name:DOUGLAS B VAUGHAN PHD PC
Entity type:Organization
Organization Name:DOUGLAS B VAUGHAN PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:816-289-1777
Mailing Address - Street 1:1524 NE DEER CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5966
Mailing Address - Country:US
Mailing Address - Phone:816-289-1777
Mailing Address - Fax:
Practice Address - Street 1:600 SW JEFFERSON ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-3988
Practice Address - Country:US
Practice Address - Phone:816-554-7705
Practice Address - Fax:816-554-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPYR0374103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MON710000Medicare UPIN