Healthcare Provider Details

I. General information

NPI: 1497290175
Provider Name (Legal Business Name): KARAH CAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309-311 GARRETT
FREDERICKTOWN MO
63645-1084
US

IV. Provider business mailing address

402 S SILVER SPRINGS RD
CAPE GIRARDEAU MO
63703-7536
US

V. Phone/Fax

Practice location:
  • Phone: 573-783-4104
  • Fax: 573-783-4572
Mailing address:
  • Phone: 573-334-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2016040354
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: