Provider Demographics
NPI:1386840205
Name:CONKLIN, HEATHER LYNETTE (MA)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LYNETTE
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3648 JASMINE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560
Mailing Address - Country:US
Mailing Address - Phone:661-860-2054
Mailing Address - Fax:
Practice Address - Street 1:1577 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CA
Practice Address - Zip Code:93523
Practice Address - Country:US
Practice Address - Phone:661-860-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CALMFT90317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist