Provider Demographics
NPI:1891372520
Name:CONKLIN, BRYAN HUTCHINSON (LCSW)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:HUTCHINSON
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 CARSON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-8885
Mailing Address - Country:US
Mailing Address - Phone:801-830-8601
Mailing Address - Fax:
Practice Address - Street 1:467 CARSON LAKE DR
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-8885
Practice Address - Country:US
Practice Address - Phone:801-830-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.09926113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health