Provider Demographics
NPI:1003307901
Name:TAURUS, MILAGRO (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:MILAGRO
Middle Name:
Last Name:TAURUS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:LAURI
Other - Middle Name:JO
Other - Last Name:MAUCK-TOMLINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:1316 NE 12TH STREET
Mailing Address - Street 2:#709
Mailing Address - City:OKLAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:73117
Mailing Address - Country:US
Mailing Address - Phone:405-979-0127
Mailing Address - Fax:
Practice Address - Street 1:6051 N BROOKLINE AVE
Practice Address - Street 2:SUITE 127
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-979-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical