Provider Demographics
NPI:1811548928
Name:DRAKE, MIRIAM STEPHENS (MED)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:STEPHENS
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 PUNTA ALTA, 3G
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637
Mailing Address - Country:US
Mailing Address - Phone:949-354-9693
Mailing Address - Fax:
Practice Address - Street 1:23832 ROCKFIELD BLVD
Practice Address - Street 2:160
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630
Practice Address - Country:US
Practice Address - Phone:949-354-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional