Provider Demographics
NPI:1164073698
Name:DRAKE, MICHELLE L (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9606 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2983
Mailing Address - Country:US
Mailing Address - Phone:503-544-7844
Mailing Address - Fax:
Practice Address - Street 1:9606 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2983
Practice Address - Country:US
Practice Address - Phone:503-544-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60512816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health