Individual
MR. BRENT PARKER TANKSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
1501C S WHEELER ST, JASPER, TX 75951-5103
(409) 622-9252
Mailing address
1204 JANE AVE, LUFKIN, TX 75901-1450
(936) 674-6559
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13677
TX
Other
Enumeration date
10/20/2017
Last updated
11/29/2021
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