MEDICARE: SARA ANN RADER MS, LPCC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPCC11688	CA

General Provider Information

NPI Number	:	1265155634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ANN RADER MS, LPCC, NCC

Provider Business Mailing Address
First Line	:	1346 LOWER DORRAY RD
Second Line	:
City	:	MOKELUMNE HILL
State	:	CA
Zip	:	95245-9622
Country	:	US
Telephone Number	:	209-890-9252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 LOWER DORRAY RD
Second Line	:
City	:	MOKELUMNE HILL
State	:	CA
Zip	:	95245-9622
Country	:	US
Telephone Number	:	209-890-9252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	07/15/2024

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