Provider Demographics
NPI:1316066202
Name:INKS, BRIAN RICHARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:RICHARD
Last Name:INKS
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 1:6321 S 33RD WEST AVE
Mailing Address - Street 2:APT. 223
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1509
Mailing Address - Country:US
Mailing Address - Phone:918-284-7115
Mailing Address - Fax:
Practice Address - Street 1:1710 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-5922
Practice Address - Country:US
Practice Address - Phone:918-747-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical