Vaughn R Jefferson PSYD Mdiv LP LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP 1666 Issued in MN

Legal business name

VAUGHN R JEFFERSON PSYD MDIV LP LLC

Practice address

1030 West County Road E
Ste 260
Shoreview, MN 55126

Phone

(651) 483-1333

Fax

(651) 789-3088

NPI assigned

Feb 25, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Vaughn Robert Jefferson, PSYD

Title

President

Phone

(651) 483-1333

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1235520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415232000000",
    "number": "1801036272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 WEST COUNTY ROAD E",
            "address_2": "STE 260",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "55126",
            "telephone_number": "651-483-1333",
            "fax_number": "651-789-3088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 WEST COUNTY ROAD E",
            "address_2": "STE 260",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "55126",
            "telephone_number": "651-483-1333",
            "fax_number": "651-789-3088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAUGHN R JEFFERSON PSYD MDIV LP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-25",
        "last_updated": "2014-11-06",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "VAUGHN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-483-1333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP 1666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "688750300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Jean Vanderwerf, ATC
• Tiffany Vang-Sutton, OTD
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• Patrick Varro, PH.D.
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• Debra Lyn Vevea, RD LD CDE
• Seth A Vogel, M.D.
• Sarah Vosen, L.AC.
• Stephen Bryan Wahman, DPM

• Clinical Psychologist in Shoreview, MN
• Providers in Shoreview, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; 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.