Provider Demographics
NPI:1104677277
Name:CARY, KATHRYN (CRADC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CARY
Suffix:
Gender:F
Credentials:CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 LONGVIEW
Mailing Address - Street 2:
Mailing Address - City:MERRIAM WOODS
Mailing Address - State:MO
Mailing Address - Zip Code:65740
Mailing Address - Country:US
Mailing Address - Phone:417-353-9678
Mailing Address - Fax:
Practice Address - Street 1:11016 E STATE HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:BRANSON WEST
Practice Address - State:MO
Practice Address - Zip Code:65737-9775
Practice Address - Country:US
Practice Address - Phone:417-220-3613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO9577101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)