Healthcare Provider Details

I. General information

NPI: 1063308757
Provider Name (Legal Business Name): CARA LYNN L BLAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 OLD 66 BLVD
JOPLIN MO
64801-7156
US

IV. Provider business mailing address

20800 OLD 66 BLVD
JOPLIN MO
64801-7156
US

V. Phone/Fax

Practice location:
  • Phone: 417-680-1184
  • Fax:
Mailing address:
  • Phone: 417-680-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023005036
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: