Provider Demographics
NPI:1396258679
Name:CONKERTON, LAURENCE DARRYL (LPC)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:DARRYL
Last Name:CONKERTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 W ARDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4239
Mailing Address - Country:US
Mailing Address - Phone:225-603-8383
Mailing Address - Fax:
Practice Address - Street 1:7520 PERKINS RD STE 180
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9130
Practice Address - Country:US
Practice Address - Phone:225-603-8383
Practice Address - Fax:225-644-3208
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional