Individual
MARK WILLIAM VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
23 NW GREENWOOD AVE, BEND, OR 97703-2078
(541) 383-4293
Mailing address
1337 SW BOARDWALK LN, BEND, OR 97702-3788
(541) 630-2458
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-23-3290
OR
175T00000X
Peer Specialist
23-CRM-2206
OR
Other
Enumeration date
08/02/2023
Last updated
11/09/2023
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