Provider Demographics
NPI:1396638771
Name:COMPASSIONATE HEARTS COUNSELING COLLABORATIVE LLC
Entity type:Organization
Organization Name:COMPASSIONATE HEARTS COUNSELING COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:MAESTAS
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-370-7595
Mailing Address - Street 1:619 N 1ST ST STE G
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4157
Mailing Address - Country:US
Mailing Address - Phone:501-436-2507
Mailing Address - Fax:
Practice Address - Street 1:619 N 1ST ST STE G
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4157
Practice Address - Country:US
Practice Address - Phone:501-436-2507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty