Active NPI
Scott Conklin, LCPC
- Counselor
- Evanston, IL
National Provider Identifier
1730410077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 180008996
- Practice address
- 636 Church St Ste 420
Evanston, IL 60201-4580 - Phone
- (312) 869-4897
- NPI assigned
- Jan 27, 2010
- Sex
- Male
- 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 | 180008996 | IL | Primary |
Addresses
Primary practice location
636 Church St Ste 420
Evanston, IL 60201-4580
Mailing address
636 Church St Ste 420
Evanston, IL 60201-4580
Phone (312) 869-4897
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 22, 2026 through Jun 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180008996 | IL | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conklin Counseling, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599782400000",
"number": "1730410077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "636 CHURCH ST STE 420",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014580",
"telephone_number": "312-869-4897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "636 CHURCH ST STE 420",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014580",
"telephone_number": "312-869-4897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "SCOTT",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-27",
"last_updated": "2020-09-11",
"certification_date": "2020-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "180008996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.