Provider Demographics
NPI:1477605863
Name:RADER, ANDREW (LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:RADER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-0185
Mailing Address - Country:US
Mailing Address - Phone:513-673-9700
Mailing Address - Fax:859-586-4636
Practice Address - Street 1:6080 CAMP ERNST RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-8354
Practice Address - Country:US
Practice Address - Phone:513-673-9700
Practice Address - Fax:859-586-4636
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0595106H00000X
IN35001537A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist