Provider Demographics
NPI:1023255106
Name:COUNSELING ASSOCIATES OF THE FOUR STATES, LLC
Entity type:Organization
Organization Name:COUNSELING ASSOCIATES OF THE FOUR STATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CORKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-387-0110
Mailing Address - Street 1:705 ILLINOIS AVE
Mailing Address - Street 2:STE 22
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5067
Mailing Address - Country:US
Mailing Address - Phone:417-627-9994
Mailing Address - Fax:417-627-9995
Practice Address - Street 1:705 ILLINOIS AVE
Practice Address - Street 2:STE 22
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5067
Practice Address - Country:US
Practice Address - Phone:417-627-9994
Practice Address - Fax:417-627-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036432101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty