Provider Demographics
NPI:1790127652
Name:BRADER, KATHERINE R (LPC, LMFTA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:BRADER
Suffix:
Gender:F
Credentials:LPC, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213A BURNET RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3316
Mailing Address - Country:US
Mailing Address - Phone:512-891-6000
Mailing Address - Fax:512-891-6003
Practice Address - Street 1:4213A BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3316
Practice Address - Country:US
Practice Address - Phone:512-891-6000
Practice Address - Fax:512-891-6003
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66393101YP2500X
TX201539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist