Provider Demographics
NPI:1083506133
Name:DRAKE, JODI LEE (MA, IMH26441, PMH-C)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LEE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MA, IMH26441, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10313 CARLSON CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7885
Mailing Address - Country:US
Mailing Address - Phone:765-543-7251
Mailing Address - Fax:765-543-7251
Practice Address - Street 1:465 MAITLAND AVE STE 16
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5444
Practice Address - Country:US
Practice Address - Phone:321-616-7225
Practice Address - Fax:407-598-7797
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH26441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health