Healthcare Provider Details

I. General information

NPI: 1376821074
Provider Name (Legal Business Name): DANIEL L DRAKE MFT, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 MOORPARK ST SUITE 111
STUDIO CITY CA
91604-2154
US

IV. Provider business mailing address

11712 MOORPARK ST SUITE 111
STUDIO CITY CA
91604-2154
US

V. Phone/Fax

Practice location:
  • Phone: 310-415-5732
  • Fax:
Mailing address:
  • Phone: 310-415-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC327
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC49986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: