Provider Demographics
NPI:1023151230
Name:FARIES, CARA NICOLE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:NICOLE
Last Name:FARIES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 SPRING MILL CRK
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-1332
Mailing Address - Country:US
Mailing Address - Phone:314-757-3121
Mailing Address - Fax:
Practice Address - Street 1:800 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7230
Practice Address - Country:US
Practice Address - Phone:636-386-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005009378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional