Provider Demographics
NPI:1518027705
Name:DRAKE, CELIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CELIA
Middle Name:A
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 N. 16TH ST.
Mailing Address - Street 2:SUITE A-120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-997-6635
Mailing Address - Fax:602-997-6642
Practice Address - Street 1:7330 N. 16TH ST.
Practice Address - Street 2:SUITE A-120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-997-6635
Practice Address - Fax:602-997-6642
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPHD 1103103T00000X
AZ1103103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
27616Medicare PIN
AZ27616Medicare PIN