Provider Demographics
NPI:1497561567
Name:RICHARDSON, VAUGHN ALEX (RBT)
Entity type:Individual
Prefix:
First Name:VAUGHN
Middle Name:ALEX
Last Name:RICHARDSON
Suffix:
Gender:X
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 NAUTICAL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2901
Mailing Address - Country:US
Mailing Address - Phone:915-336-6569
Mailing Address - Fax:
Practice Address - Street 1:1605 GEORGE DIETER DR STE 308
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5686
Practice Address - Country:US
Practice Address - Phone:915-257-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-356071106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician