Provider Demographics
NPI:1497200968
Name:DRAKE, HEATHER (LSCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1728
Mailing Address - Country:US
Mailing Address - Phone:913-269-1748
Mailing Address - Fax:
Practice Address - Street 1:5231 ABERDEEN RD
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-1728
Practice Address - Country:US
Practice Address - Phone:913-269-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCRAADC #1476101YA0400X
KSLSCSW #14531041C0700X
MOLCSW #0044581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)