Provider Demographics
NPI:1255688982
Name:CANADY, CARA AURORA
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:AURORA
Last Name:CANADY
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 1:10504 TIMBERCREST LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1643
Mailing Address - Country:US
Mailing Address - Phone:512-567-9591
Mailing Address - Fax:
Practice Address - Street 1:401 NE 46TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-3309
Practice Address - Country:US
Practice Address - Phone:405-602-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 247200000X
TX84997101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other