Provider Demographics
NPI:1518431121
Name:NADER, MARY KATHRYN (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:NADER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 SANTA FE DR UNIT 1706
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-3859
Mailing Address - Country:US
Mailing Address - Phone:817-458-2482
Mailing Address - Fax:817-609-4545
Practice Address - Street 1:134 EL CHICO TRL STE 105
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-8862
Practice Address - Country:US
Practice Address - Phone:817-458-2482
Practice Address - Fax:817-609-4545
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional