Healthcare Provider Details

I. General information

NPI: 1790127652
Provider Name (Legal Business Name): KATHERINE R BRADER LMFT, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2013
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 W NC HIGHWAY 54 STE 603
DURHAM NC
27707-5599
US

IV. Provider business mailing address

2410 ENVIRON WAY
CHAPEL HILL NC
27517-4460
US

V. Phone/Fax

Practice location:
  • Phone: 919-900-0123
  • Fax:
Mailing address:
  • Phone: 919-745-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66393
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11313
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number201539
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1671
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: