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General NPI Number Information
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NPI Number | 1396638771
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE HEARTS COUNSELING COLLABORATIVE LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 619 N 1ST ST STE G
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4157
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Country | US
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Telephone | 501-436-2507
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Fax |
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Provider Business Mailing Address
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Address Line | 619 N 1ST ST STE G
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4157
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Country | US
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Telephone | 501-436-2507
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | GABRIELA MAESTAS O'DELL
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Credential | LPC
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Telephone | 210-370-7595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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