Healthcare Provider Details

I. General information

NPI: 1427042076
Provider Name (Legal Business Name): CARA RAE JOHNSON MSW, PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date: 03/25/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

809 MEDICAL PARK DR STE 102
MEXICO MO
65265-3753
US

IV. Provider business mailing address

PO BOX 203
MEXICO MO
65265-0203
US

V. Phone/Fax

Practice location:
  • Phone: 913-730-0035
  • Fax: 660-662-2220
Mailing address:
  • Phone: 913-730-0035
  • Fax: 660-662-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2006016141
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2006016141
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: