Healthcare Provider Details

I. General information

NPI: 1376028035
Provider Name (Legal Business Name): KARA NICOLE SHRADER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARA NICOLE SATCHES

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 01/01/2022
Certification Date: 01/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 OLD US 66
EDGEWOOD NM
87015
US

IV. Provider business mailing address

PO BOX 9
EDGEWOOD NM
87015-0009
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-2743
  • Fax:
Mailing address:
  • Phone: 505-750-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTL0199441
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: