MEDICARE: MRS. JOY LYNN CONKLIN M.S., LPC, NCC, NSCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC003064	GA
2	101YS0200X	School Counselor	430877	GA

General Provider Information

NPI Number	:	1134452485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOY LYNN CONKLIN M.S., LPC, NCC, NSCC

Provider Business Mailing Address
First Line	:	130 GOVERNORS SQ STE A
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-4862
Country	:	US
Telephone Number	:	678-364-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 GOVERNORS SQ STE A
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-4862
Country	:	US
Telephone Number	:	678-364-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/17/2009

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