Provider Demographics
NPI:1801539572
Name:VAUGHAN, KATHERINE IVEY MARIE (LMFTA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:IVEY MARIE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11757 WILD PEAR LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8816
Mailing Address - Country:US
Mailing Address - Phone:817-657-4631
Mailing Address - Fax:
Practice Address - Street 1:11757 WILD PEAR LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8816
Practice Address - Country:US
Practice Address - Phone:817-657-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204361101YM0800X, 101YP1600X, 101YP2500X, 106H00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker