Individual
DR. CARL GEORGE CONKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA-D
Contact information
Practice address
6224 CLOUD DANCE DR, LAS CRUCES, NM 88012-9017
(785) 727-9270
Mailing address
6224 CLOUD DANCE DR, LAS CRUCES, NM 88012-9017
(785) 727-9270
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-03-1250
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88012 0000
TRIWEST
NM
Enumeration date
06/03/2012
Last updated
06/03/2012
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