| Counseling Associates Of The Four States, Llc | |
|
705 Illinois Ave Ste 22 Joplin MO 64801-5067 | |
| (417) 627-9994 | |
| (417) 627-9995 |
| Full Name | Counseling Associates Of The Four States, Llc |
|---|---|
| Speciality | Counselor |
| Location | 705 Illinois Ave, Joplin, Missouri |
| Authorized Official Name and Position | Jacob Corklin (OWNER/THERAPIST) |
| Authorized Official Contact | 4793870110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Counseling Associates Of The Four States, Llc 705 Illinois Ave Ste 22 Joplin MO 64801-5067 Ph: (417) 627-9994 | Counseling Associates Of The Four States, Llc 705 Illinois Ave Ste 22 Joplin MO 64801-5067 Ph: (417) 627-9994 |
| NPI Number | 1023255106 |
|---|---|
| Provider Enumeration Date | 01/12/2009 |
| Last Update Date | 12/15/2023 |
| Medicare PECOS PAC ID | 7012160435 |
|---|---|
| Medicare Enrollment ID | O20130116000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023255106 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 2008036432 (Missouri) | Primary |
| Provider Name | John R Spooner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750351409 PECOS PAC ID: 7719084151 Enrollment ID: I20070521000317 |
| Provider Name | Grant T Collings |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346588787 PECOS PAC ID: 3476873506 Enrollment ID: I20150513001281 |
| Provider Name | Diana L Collings |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144238221 PECOS PAC ID: 9638453087 Enrollment ID: I20170302000191 |
| Provider Name | Elizabeth C Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740735497 PECOS PAC ID: 3678801685 Enrollment ID: I20190828001755 |
| Provider Name | Jacob Russell Conklin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518320951 PECOS PAC ID: 5294258968 Enrollment ID: I20250403000381 |
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