Provider Demographics
NPI:1164138954
Name:COMPASSIONATE INNER AWAKENINGS COUNSELING, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE INNER AWAKENINGS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:PORTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:417-499-3673
Mailing Address - Street 1:1531 W 32ND ST STE 208B
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1611
Mailing Address - Country:US
Mailing Address - Phone:417-499-3673
Mailing Address - Fax:
Practice Address - Street 1:1531 W 32ND ST STE 208B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1889
Practice Address - Country:US
Practice Address - Phone:417-499-3673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty