Healthcare Provider Details

I. General information

NPI: 1871408302
Provider Name (Legal Business Name): BRIAN DRAKE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 N GILMORE RD
FAIRFIELD OH
45014-2115
US

IV. Provider business mailing address

400 N ERIE HWY STE A
HAMILTON OH
45011-4264
US

V. Phone/Fax

Practice location:
  • Phone: 513-829-8300
  • Fax:
Mailing address:
  • Phone: 513-887-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: