Individual
MRS. BERTHA VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AMFT, APCC
Contact information
Practice address
1845 CHICAGO AVE STE B, RIVERSIDE, CA 92507-2366
(951) 465-3664
Mailing address
3940 DAWES ST APT 71, RIVERSIDE, CA 92503-3538
(323) 817-9627
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E2935267
DRIVERS LICENSE
CA
Enumeration date
02/24/2022
Last updated
02/24/2022
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