Provider Demographics
NPI:1477342566
Name:MCGAUGH, MISTY LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:LYNN
Last Name:MCGAUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545 VILLAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-8207
Mailing Address - Country:US
Mailing Address - Phone:405-618-3964
Mailing Address - Fax:
Practice Address - Street 1:416 S MUSTANG RD STE B
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7314
Practice Address - Country:US
Practice Address - Phone:405-254-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7857104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker