Provider Demographics
NPI:1215736517
Name:SUPPORTIVE SPACES COUNSELING
Entity type:Organization
Organization Name:SUPPORTIVE SPACES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-448-7299
Mailing Address - Street 1:1601 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-1727
Mailing Address - Country:US
Mailing Address - Phone:417-667-1677
Mailing Address - Fax:417-530-1479
Practice Address - Street 1:1601 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-1727
Practice Address - Country:US
Practice Address - Phone:417-667-1677
Practice Address - Fax:417-530-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty