Healthcare Provider Details

I. General information

NPI: 1134589807
Provider Name (Legal Business Name): JEFFREY EDWARD DRAKE LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 RILEY AVE
WORTHINGTON OH
43085-3087
US

IV. Provider business mailing address

544 RILEY AVE
WORTHINGTON OH
43085-3087
US

V. Phone/Fax

Practice location:
  • Phone: 614-906-8505
  • Fax:
Mailing address:
  • Phone: 614-906-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1000369
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2203119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: