Ryan Vaughn
Individual provider Active NPI Professional Counselor · Goode, VA
NPI 1174998959 · NPPES record last updated Dec 5, 2015
Key facts
- NPI
- 1174998959
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 0701006370 (VA)
- Practice address
- 2365 Cifax Rd
Goode, VA 24556-2896 - Phone
- (979) 824-6349
- NPI assigned
- Dec 5, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701006370 | VA | MD | Professional Counselor |
| 0717001360 | VA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christian Counseling Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701006370 | VA | Yes |
| Marriage & Family Therapist | 106H00000X | 0717001360 | VA |
Addresses
Primary practice location
2365 Cifax Rd
Goode, VA 24556-2896
Mailing address
2365 Cifax Rd
Goode, VA 24556-2896
Phone (979) 824-6349
Other providers in Goode, VA
- J&K Home Care Inc.
- Kelly Etemadipour Koppenal
- McMann Chiropractic LLC
- Practiclear PLLC
- Matthew Paul Vanalstine
- Brandon Keith White
- Julia M.K. White
All providers in Goode, VA · Professional Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.