Provider Demographics
NPI:1679748230
Name:DAVIS, KARA
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E STATE HIGHWAY CC
Mailing Address - Street 2:SUITE A 105
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:380 E STATE HIGHWAY CC
Practice Address - Street 2:SUITE A 105
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7337
Practice Address - Country:US
Practice Address - Phone:417-725-8810
Practice Address - Fax:417-725-6206
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007014804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional