Healthcare Provider Details

I. General information

NPI: 1083564835
Provider Name (Legal Business Name): KATHRYN DRAKE P-LPC, LPMT, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2026
Last Update Date: 01/31/2026
Certification Date: 01/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 LAMAR AVE
HATTIESBURG MS
39402-1825
US

IV. Provider business mailing address

602 LAMAR AVE
HATTIESBURG MS
39402-1825
US

V. Phone/Fax

Practice location:
  • Phone: 228-280-9028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP-1267
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberMT-1
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: