Provider Demographics
NPI:1376897595
Name:CONKLIN, KATHRYN ISABEL (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ISABEL
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 CAMINO DEL RIO S STE 318
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4108
Mailing Address - Country:US
Mailing Address - Phone:619-518-1784
Mailing Address - Fax:
Practice Address - Street 1:4025 CAMINO DEL RIO S STE 318
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4108
Practice Address - Country:US
Practice Address - Phone:619-518-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist