Provider Demographics
NPI:1922004787
Name:HARTFIELD, CARA R (PHD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:R
Last Name:HARTFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W CENTER ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6034
Mailing Address - Country:US
Mailing Address - Phone:479-409-2212
Mailing Address - Fax:479-439-8550
Practice Address - Street 1:112 W CENTER ST
Practice Address - Street 2:SUITE 215
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6034
Practice Address - Country:US
Practice Address - Phone:479-409-2212
Practice Address - Fax:479-439-8550
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024792103TC0700X
AR06-15 P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495445603Medicaid
MO00071243Medicare ID - Type Unspecified