Healthcare Provider Details

I. General information

NPI: 1215383948
Provider Name (Legal Business Name): BRENDA DRAKE LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA FRELIX

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HIGHWAY 80 W STE R
CLINTON MS
39056-4108
US

IV. Provider business mailing address

207 TRAILWOOD DR
CLINTON MS
39056-5844
US

V. Phone/Fax

Practice location:
  • Phone: 601-906-5323
  • Fax:
Mailing address:
  • Phone: 601-906-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1723
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: