Provider Demographics
NPI:1013183391
Name:DRAKE, KERRY (LPC)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:
Last Name:DRAKE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 YONKERS ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-1826
Mailing Address - Country:US
Mailing Address - Phone:806-293-2636
Mailing Address - Fax:806-296-5804
Practice Address - Street 1:2700 YONKERS ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1826
Practice Address - Country:US
Practice Address - Phone:806-293-2636
Practice Address - Fax:806-296-5804
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028125501Medicaid