Provider Demographics
NPI:1225126857
Name:DRAXTON, DAVE (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVE
Middle Name:
Last Name:DRAXTON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 NORTH NEVADA AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-475-8038
Mailing Address - Fax:719-475-0993
Practice Address - Street 1:1414 NORTH NEVADA AVENUE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-475-8038
Practice Address - Fax:719-475-0993
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1622101YP2500X
COLPC#1622101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional