Provider Demographics
NPI:1437836590
Name:CONKLIN THERAPY COLLECTIVE
Entity Type:Organization
Organization Name:CONKLIN THERAPY COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:424-281-7209
Mailing Address - Street 1:2 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4010
Mailing Address - Country:US
Mailing Address - Phone:424-281-7209
Mailing Address - Fax:
Practice Address - Street 1:2 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4010
Practice Address - Country:US
Practice Address - Phone:424-281-7209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health