Provider Information for 1457539934
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KRYSTAL MICHELLE VAUGHN LPC
Sex: Female
NPI: 1457539934
Last Updated: 2008-02-06
Certification Date:
Certification Date:
Details
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NPI | 1457539934 | ||||||||
Enumeration Date | 2008-02-06 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 8873 QUIMPER PL SHREVEPORT, LA 71105-5620 United States Phone: 318-686-0012 | Fax:318-686-0012 | ||||||||
Primary Practice Address | 8873 QUIMPER PL SHREVEPORT, LA 71105-5620 United States Phone: 318-686-0012 | Fax:318-686-0012 | ||||||||
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