Jacob Russell Conklin, M.S., NCC, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPCC.0014244 Issued in CO

Practice address

1180 S Holly St
Denver, CO 80246-3233

Phone

(479) 387-0110

NPI assigned

Apr 2, 2016

Last updated

Apr 2, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Counseling Associates of the Four States LLCGroup PAC ID 7012160435, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Counseling Associates of the Four States, LLC

  • Mental Health Counselor
  • Joplin, MO
  • NPI 1023255106
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1459555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459555200000",
    "number": "1518320951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 S HOLLY ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802463233",
            "telephone_number": "479-387-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 S HOLLY ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802463233",
            "telephone_number": "479-387-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONKLIN",
        "first_name": "JACOB",
        "middle_name": "RUSSELL",
        "name_prefix": "Mr.",
        "credential": "M.S., NCC, LPCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-02",
        "last_updated": "2016-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "LPCC.0014244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Conifer Care Communities a, LLC (Amberwood Court Rehabilitation and Care Community)
• Conifer Care Communities B, LLC (Brookshire House Rehabilitation and Care Community)
• Conifer Care Communities B, LLC (Brookshire House Rehabilitation and Care Community)
• Karen Conklin-Johnson, LPC
• Emily Anne Conklin
• Trenten Conkling, PA
• Edward S Conlan, M.D.
• Amy Leigh Conley, LCSW
• Kristin Ann Conley, IBCLC
• Samantha Nichole Conley, M.S. SLP CCC

• Mental Health Counselor in Denver, CO
• Providers in Denver, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.