Provider Demographics
NPI:1508172180
Name:DRAKE, AMY L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-1665
Mailing Address - Country:US
Mailing Address - Phone:574-453-7454
Mailing Address - Fax:
Practice Address - Street 1:117 W 9TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2224
Practice Address - Country:US
Practice Address - Phone:260-925-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN34006389A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health