Healthcare Provider Details

I. General information

NPI: 1619648235
Provider Name (Legal Business Name): ELISHA DRAKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 RIM ROCK RD
ALEDO TX
76008-3983
US

IV. Provider business mailing address

137 RIM ROCK RD
ALEDO TX
76008-3983
US

V. Phone/Fax

Practice location:
  • Phone: 817-559-0993
  • Fax:
Mailing address:
  • Phone: 817-559-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number78820
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: