Healthcare Provider Details

I. General information

NPI: 1083506133
Provider Name (Legal Business Name): JODI LEE DRAKE MA, IMH26441, PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MAITLAND AVE STE 16
ALTAMONTE SPRINGS FL
32701-5444
US

IV. Provider business mailing address

10313 CARLSON CIR
CLERMONT FL
34711-7885
US

V. Phone/Fax

Practice location:
  • Phone: 321-616-7225
  • Fax: 407-598-7797
Mailing address:
  • Phone: 765-543-7251
  • Fax: 765-543-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: