Healthcare Provider Details

I. General information

NPI: 1902747835
Provider Name (Legal Business Name): TIFFANY DRAKE LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 MAIN AVE OFC 4A
DURANGO CO
81301-4699
US

IV. Provider business mailing address

101 ALAMO DR
DURANGO CO
81301-4633
US

V. Phone/Fax

Practice location:
  • Phone: 719-395-1223
  • Fax:
Mailing address:
  • Phone: 719-395-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number.0015831
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: