Healthcare Provider Details

I. General information

NPI: 1497370241
Provider Name (Legal Business Name): KARLEE A DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 N BUTLER AVE
FARMINGTON NM
87401-5621
US

IV. Provider business mailing address

1209 IRIS DR
AZTEC NM
87410-2511
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-2552
  • Fax:
Mailing address:
  • Phone: 909-762-1456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: