Provider Demographics
NPI:1235488198
Name:DRAKE, CHASTITY (LPC)
Entity Type:Individual
Prefix:
First Name:CHASTITY
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHASTITY
Other - Middle Name:
Other - Last Name:KAESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2519 N HILLCREST PKWY, STE 201
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2588
Mailing Address - Country:US
Mailing Address - Phone:715-832-8432
Mailing Address - Fax:715-832-5007
Practice Address - Street 1:2519 N HILLCREST PKWY, STE 201
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2588
Practice Address - Country:US
Practice Address - Phone:715-832-8432
Practice Address - Fax:715-832-5007
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4872-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional