Provider Demographics
NPI:1477156040
Name:DRAKE, MARCUS LONDYN
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:LONDYN
Last Name:DRAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 E CRAIG RD APT 1187
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2510
Mailing Address - Country:US
Mailing Address - Phone:563-639-9823
Mailing Address - Fax:
Practice Address - Street 1:4185 VEGAS VALLEY DR STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2522
Practice Address - Country:US
Practice Address - Phone:702-463-9066
Practice Address - Fax:702-463-9067
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2106114604103K00000X
NV2106114604106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst