Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 6301011744 | MI |
N | 102L00000X | Psychologist | 6301011744 | MI |
N | 103T00000X | Psychologist | 6301011744 | MI |
NPI | 1013160159 |
---|---|
Provider Name | Mrs. Pamela Marie Vaughan |
First Address | Birmingham, MI 48009-7600 |
Second Address | Bloomfield Hills, MI 48304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 31/07/2018 |