Provider Demographics
NPI:1609387836
Name:KNIGHTON, CONWAY L (LPC)
Entity Type:Individual
Prefix:MR
First Name:CONWAY
Middle Name:L
Last Name:KNIGHTON
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 1:4420 RUE SPLENDEUR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3838
Mailing Address - Country:US
Mailing Address - Phone:225-610-2990
Mailing Address - Fax:
Practice Address - Street 1:2156 WOODALE BLVD
Practice Address - Street 2:SUITE 750
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-444-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203101YP2500X
LAMFT348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional