Provider Demographics
NPI:1790978062
Name:BURNS, TAYLOR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 E 71ST ST
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6346
Mailing Address - Country:US
Mailing Address - Phone:918-760-9796
Mailing Address - Fax:
Practice Address - Street 1:5215 E 71ST ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6346
Practice Address - Country:US
Practice Address - Phone:918-760-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical