NPIMap

Organization Active NPI

Counseling Associates of the Four States, LLC

  • Mental Health Counselor
  • Joplin, MO
National Provider Identifier
1023255106
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
COUNSELING ASSOCIATES OF THE FOUR STATES, LLC
Practice address
705 W 26TH St
Joplin, MO 64804-1904
Phone
(417) 627-9994
Fax
(417) 627-9995
NPI assigned
Jan 12, 2009
Last updated
Nov 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacob Russell Conklin, LPCNPI 1518320951
Title
Owner, LPC
Phone
(417) 627-9994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

705 W 26TH St
Joplin, MO 64804-1904

Mailing address

705 W 26TH St
Joplin, MO 64804-1904
Phone (417) 627-9994

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130116000208 MO Part B Supplier - Clinic/Group Practice 7012160435 Receives reassigned benefits from 15 practitioners
Practice locations: Joplin, MO

National Provider Directory

National Provider Directory

Locations

705 Illinois Ave
Ste 22
Joplin, MO 64801
Phone (417) 627-9994

705 W 26th St
Joplin, MO 64804
Phone (417) 627-9994

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762819200000",
    "number": "1023255106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 W 26TH ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041904",
            "telephone_number": "417-627-9994",
            "fax_number": "417-627-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 W 26TH ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041904",
            "telephone_number": "417-627-9994",
            "fax_number": "417-627-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNSELING ASSOCIATES OF THE FOUR STATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-12",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A",
        "authorized_official_last_name": "CONKLIN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER, LPC",
        "authorized_official_telephone_number": "417-627-9994",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.