Provider Demographics
NPI:1659623809
Name:CONKLIN, THOMAS ANTHONY (LPC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:CONKLIN
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 1:405 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1233
Mailing Address - Country:US
Mailing Address - Phone:646-335-3826
Mailing Address - Fax:
Practice Address - Street 1:405 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BRADLEY BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07720-1233
Practice Address - Country:US
Practice Address - Phone:646-335-3826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00545000101YM0800X
NJ37AC0013330101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor