Active NPI
Marsha Jo Conklin
- Counselor
- Casselberry, FL
National Provider Identifier
1073242467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- MH6949
- Practice address
- 1023 Spring Lily PT Apt 101
Casselberry, FL 32707-5470 - Phone
- (407) 335-6755
- NPI assigned
- Jun 9, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | MH6949 | FL | Primary |
Addresses
Primary practice location
1023 Spring Lily PT Apt 101
Casselberry, FL 32707-5470
Mailing address
1023 Spring Lily PT Apt 101
Casselberry, FL 32707-5470
Phone (407) 335-6755
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH6949 | FL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654732800000",
"number": "1073242467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1023 SPRING LILY PT APT 101",
"city": "CASSELBERRY",
"state": "FL",
"postal_code": "327075470",
"telephone_number": "407-335-6755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1023 SPRING LILY PT APT 101",
"city": "CASSELBERRY",
"state": "FL",
"postal_code": "327075470",
"telephone_number": "407-335-6755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "MARSHA",
"middle_name": "JO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-09",
"last_updated": "2022-06-09",
"certification_date": "2022-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "FL",
"license": "MH6949",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Casselberry, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.