| Organization Name: | COUNSELING ASSOCIATES OF THE FOUR STATES, LLC |
| NPI Number: | 1023255106 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEANNA L STREET (MANAGER) |
| Mailing Address: | 705 Illinois Ave Ste 22 Joplin |
| State: | MO US |
| Postal Code: | 648015067 |
| Phone Number: | 4176279994 |
| Fax Number: | 4176279995 |
| NPI Enumeration Date: | 01/12/2009 |
| NPI Last Update Date: | 10/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2008036432 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |