Provider Demographics
NPI:1104952431
Name:WINKLER, BRIAN L (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:WINKLER
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 1:4144 LINDELL BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108
Mailing Address - Country:US
Mailing Address - Phone:314-531-3300
Mailing Address - Fax:314-531-7587
Practice Address - Street 1:4144 LINDELL BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-531-3300
Practice Address - Fax:314-531-7587
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
120354OtherVALUE OPTIONS