Provider Demographics
NPI:1740855204
Name:RADER, SARA MICHELLE (LPCC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MICHELLE
Last Name:RADER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MICHELLE
Other - Last Name:LUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10401 LINN STATION RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3842
Mailing Address - Country:US
Mailing Address - Phone:502-589-8600
Mailing Address - Fax:
Practice Address - Street 1:914 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1037
Practice Address - Country:US
Practice Address - Phone:502-587-8833
Practice Address - Fax:502-589-8758
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY269206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional