NPIMap

Organization Active NPI

Jennifer Vaughn Therapy Services LLC

  • Community/Behavioral Health Agency
  • Nisswa, MN
National Provider Identifier
1609290691
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
2090 Issued in MN
Legal business name
JENNIFER VAUGHN THERAPY SERVICES LLC
Practice address
25282 Hazelwood Dr Ste 1
Nisswa, MN 56468-2976
Phone
(218) 820-7671
Fax
(218) 600-5500
NPI assigned
Feb 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Anne-Song Vaughn, LMFTNPI 1710260708
Title
Owner
Phone
(218) 820-6626

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Community/Behavioral Health Agency 251S00000X 2090 MN Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

25282 Hazelwood Dr Ste 1
Nisswa, MN 56468-2976

Mailing address

4682 Wilderness CT # 103
Brainerd, MN 56401-2834
Phone (218) 820-6626

Other practice location 1

107 Doctors Park
Saint Cloud, MN 56303-1207
Phone (218) 820-7671

Other practice location 2

4682 Wilderness Ct # 103
Brainerd, MN 56401-2834
Phone (218) 820-7671

Other identifiers 1

IdentifierTypeStateIssuer
1710260708OtherNPI INDIVIDUAL NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777852800000",
    "number": "1609290691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4682 WILDERNESS CT # 103",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012834",
            "telephone_number": "218-820-6626",
            "fax_number": "218-600-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25282 HAZELWOOD DR STE 1",
            "city": "NISSWA",
            "state": "MN",
            "postal_code": "564682976",
            "telephone_number": "218-820-7671",
            "fax_number": "218-600-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 Doctors Park",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563031207",
            "country_code": "US",
            "telephone_number": "218-820-7671",
            "fax_number": "218-600-5500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4682 Wilderness Ct # 103",
            "address_purpose": "LOCATION",
            "city": "Brainerd",
            "state": "MN",
            "postal_code": "564012834",
            "country_code": "US",
            "telephone_number": "218-820-7671",
            "fax_number": "218-600-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JENNIFER VAUGHN THERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-11",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "ANNE-SONG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-820-6626",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "2090",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL NUMBER",
            "identifier": "1710260708",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nisswa, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.