Brianna Conklin, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

37PC00790100 Issued in NJ

Practice address

26 S Maple Ave
Marlton, NJ 08053-2002

Phone

(609) 314-3542

NPI assigned

Sep 24, 2018

Last updated

Mar 17, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.briannaconklin@148376.advancedmd-direct.com

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.

• Marlton Counseling Center

  • Mental Health Counselor
  • Marlton, NJ
  • NPI 1548147937
  NPD Authorized official
• New Jersey Behavioral Health P.C

  • Psychologist
  • Princeton Junction, NJ
  • NPI 1538744297
  NPD (past)
• PHC of Buffalo Grove Clinical Psychology

  dba Portrait Health Centers

  • Psychologist
  • Vernon Hills, IL
  • NPI 1235430612
  NPD (past)

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1861976086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 S MAPLE AVE",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532002",
            "telephone_number": "609-314-3542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 S MAPLE AVE",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532002",
            "telephone_number": "609-314-3542"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "740 Marne Hwy",
            "address_purpose": "LOCATION",
            "city": "Moorestown",
            "state": "NJ",
            "postal_code": "080573126",
            "country_code": "US",
            "telephone_number": "732-982-2888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONKLIN",
        "first_name": "BRIANNA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-24",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37PC00790100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "hippa compliant practice software",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct messaging",
            "address_1": "26 S Maple Ave",
            "city": "Marlton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080532002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.

Verify at the official NPI Registry.