Provider Demographics
NPI:1518320951
Name:CONKLIN, JACOB RUSSELL (MS, NCC, LPCC)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:RUSSELL
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:MS, NCC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3233
Mailing Address - Country:US
Mailing Address - Phone:479-387-0110
Mailing Address - Fax:
Practice Address - Street 1:1180 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3233
Practice Address - Country:US
Practice Address - Phone:479-387-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0014244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health