Healthcare Provider Details

I. General information

NPI: 1588918536
Provider Name (Legal Business Name): KRYSTAL LYNNE DRAKE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 OAK TREE BLVD STE 200
INDEPENDENCE OH
44131-6914
US

IV. Provider business mailing address

6100 OAK TREE BLVD STE 200
INDEPENDENCE OH
44131-6914
US

V. Phone/Fax

Practice location:
  • Phone: 216-532-3389
  • Fax: 216-247-1676
Mailing address:
  • Phone: 216-532-3389
  • Fax: 216-247-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.7548
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2012035182
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberP.7548
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberP.7548
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: