Provider Demographics
NPI:1760443444
Name:DRAKE, TRACI LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:LEE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:9601 STEILACOOM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-7212
Mailing Address - Country:US
Mailing Address - Phone:253-756-2991
Mailing Address - Fax:253-756-2879
Practice Address - Street 1:9601 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-7212
Practice Address - Country:US
Practice Address - Phone:253-756-2991
Practice Address - Fax:253-756-2879
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003290103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8858726Medicare PIN
WAQ64466Medicare UPIN