Healthcare Provider Details

I. General information

NPI: 1144978297
Provider Name (Legal Business Name): DARREN RANDALL DRAKE CPC-INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S JONES BLVD
LAS VEGAS NV
89146-1260
US

IV. Provider business mailing address

1901 S JONES BLVD
LAS VEGAS NV
89146-1260
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-7865
  • Fax: 702-486-9653
Mailing address:
  • Phone: 702-486-7865
  • Fax: 702-486-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: