Healthcare Provider Details

I. General information

NPI: 1497969133
Provider Name (Legal Business Name): LAWRENCE DILKS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MAPLEWOOD DR STE 1
SULPHUR LA
70663-6100
US

IV. Provider business mailing address

2500 MAPLEWOOD DR STE 1
SULPHUR LA
70663-6100
US

V. Phone/Fax

Practice location:
  • Phone: 337-533-8035
  • Fax: 337-625-6968
Mailing address:
  • Phone: 337-533-8035
  • Fax: 337-625-6968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number386
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number386
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: