Provider Demographics
NPI:1609335165
Name:SHANKS, CARA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:MARIE
Last Name:SHANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1074 S GETTYSBURG LOOP
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-4236
Mailing Address - Country:US
Mailing Address - Phone:417-268-8378
Mailing Address - Fax:
Practice Address - Street 1:1074 S GETTYSBURG LOOP
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-4236
Practice Address - Country:US
Practice Address - Phone:417-268-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190067451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty