Provider Demographics
NPI:1689073629
Name:SRADER, MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:SRADER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CANYON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-3701
Mailing Address - Country:US
Mailing Address - Phone:409-200-2220
Mailing Address - Fax:409-440-3344
Practice Address - Street 1:105 CANYON LAKE CIR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-3701
Practice Address - Country:US
Practice Address - Phone:409-200-2220
Practice Address - Fax:409-440-3344
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker