Provider Demographics
NPI:1902341985
Name:DRAKE, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:LOVELOCK
Mailing Address - State:NV
Mailing Address - Zip Code:89419-1433
Mailing Address - Country:US
Mailing Address - Phone:775-455-5232
Mailing Address - Fax:
Practice Address - Street 1:240 WILLOWDRIVE
Practice Address - Street 2:
Practice Address - City:LOVELOCK
Practice Address - State:NV
Practice Address - Zip Code:89419
Practice Address - Country:US
Practice Address - Phone:775-455-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health