Provider Demographics
NPI:1649530023
Name:KIRLIC, NAMIK (PHD)
Entity type:Individual
Prefix:DR
First Name:NAMIK
Middle Name:
Last Name:KIRLIC
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 W EASTON ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-6903
Mailing Address - Country:US
Mailing Address - Phone:617-800-4028
Mailing Address - Fax:
Practice Address - Street 1:1304 W EASTON ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-6903
Practice Address - Country:US
Practice Address - Phone:617-800-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1333103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical