Jeff Donovan Conklin

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PSY 24549 Issued in CA

Practice address

565 Brunswick Rd
Ste 10
Grass Valley, CA 95945-9529

Phone

(530) 575-9056

Fax

(530) 271-5992

NPI assigned

Apr 24, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2008

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Victor Community Support Services, Inc

  • Community/Behavioral Health Agency
  • Grass Valley, CA
  • NPI 1316127434
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628726400000",
    "number": "1215102991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11099 SUCCESS CROSS RD",
            "city": "NEVADA CITY",
            "state": "CA",
            "postal_code": "959593470",
            "telephone_number": "530-575-9056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 BRUNSWICK RD",
            "address_2": "STE 10",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959459529",
            "telephone_number": "530-575-9056",
            "fax_number": "530-271-5992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONKLIN",
        "first_name": "JEFF",
        "middle_name": "DONOVAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-24",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY24549",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "PSY 24549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles G Comerate
• Common Goals, Inc.
• Common Goals, Inc.
• Common Purpose
• Erin Compton
• Melanie Conley, DPT
• Polly Kay Conley, R.N., P.N.P
• Tracey Renee Connell, PA
• Erin Connolly, MS
• Tomi M Connors Corbett, PT

• Mental Health Counselor in Grass Valley, CA
• Providers in Grass Valley, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.