Provider Demographics
NPI:1720086937
Name:CONKLIN, WILLIAM EDWARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 W 1ST NORTH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4549
Mailing Address - Country:US
Mailing Address - Phone:423-581-5342
Mailing Address - Fax:423-581-8650
Practice Address - Street 1:929 W 1ST NORTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4549
Practice Address - Country:US
Practice Address - Phone:423-581-5342
Practice Address - Fax:423-581-8650
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36850381Medicare PIN