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General NPI Number Information
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NPI Number | 1376028035
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Entity Type | Individual
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Provider Name | KARA NICOLE SHRADER LPCC
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Gender | Female
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 01/01/2022
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Provider Practice Location Address
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Address Line | 1637 OLD US 66
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City | EDGEWOOD
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State | NM
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Zip | 87015
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Country | US
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Telephone | 505-750-2743
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | EDGEWOOD
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State | NM
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Zip | 87015-0009
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Country | US
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Telephone | 505-750-2743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CTL0199441
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License Number State | NM
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