Healthcare Provider Details

I. General information

NPI: 1518027705
Provider Name (Legal Business Name): CELIA A. DRAKE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 N. 16TH ST. SUITE A-120
PHOENIX AZ
85020
US

IV. Provider business mailing address

7330 N. 16TH ST. SUITE A-120
PHOENIX AZ
85020
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-6635
  • Fax: 602-997-6642
Mailing address:
  • Phone: 602-997-6635
  • Fax: 602-997-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPHD 1103
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1103
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: