MEDICARE: KATHRYN CARY CRADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	9577	MO

General Provider Information

NPI Number	:	1104677277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN CARY CRADC

Provider Business Mailing Address
First Line	:	2010 LONGVIEW
Second Line	:
City	:	MERRIAM WOODS
State	:	MO
Zip	:	65740
Country	:	US
Telephone Number	:	417-353-9678
Fax Number	:

Provider Business Practice Location Address
First Line	:	11016 E STATE HIGHWAY 76
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-9775
Country	:	US
Telephone Number	:	417-220-3613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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