Active NPI
Glenn Vaughn, LCPC
- Counselor
- Coeur D Alene, ID
National Provider Identifier
1699164236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LCPC-5394
- Practice address
- 416 E Foster Ave
2488 Merritt Creek Loop Suite Number 2C
Coeur D Alene, ID 83814-3045 - Phone
- (208) 659-3931
- NPI assigned
- Jan 20, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LCPC-5394 | ID | Primary |
Addresses
Primary practice location
416 E Foster Ave
2488 Merritt Creek Loop Suite Number 2C
Coeur D Alene, ID 83814-3045
Mailing address
416 E Foster Ave
Coeur D Alene, ID 83814-3045
Phone (208) 659-3931
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 15, 2024 through Aug 15, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC-5394 | ID | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421712000000",
"number": "1699164236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "416 E FOSTER AVE",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838143045",
"telephone_number": "208-659-3931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "416 E FOSTER AVE",
"address_2": "2488 MERRITT CREEK LOOP SUITE NUMBER 2C",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838143045",
"telephone_number": "208-659-3931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAUGHN",
"first_name": "GLENN",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-20",
"last_updated": "2015-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "ID",
"license": "LCPC-5394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.