Provider Demographics
NPI:1609417450
Name:DRAKE, TRAVIS PAUL (LPCA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:PAUL
Last Name:DRAKE
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 LARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-8847
Mailing Address - Country:US
Mailing Address - Phone:606-481-1609
Mailing Address - Fax:
Practice Address - Street 1:1200 LARKWOOD DR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-8847
Practice Address - Country:US
Practice Address - Phone:606-481-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260120101YP2500X
KY283015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional