Provider Demographics
NPI:1063752764
Name:DRAKE, JAMES J (LPC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:DRAKE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 W DENTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9326
Mailing Address - Country:US
Mailing Address - Phone:208-577-4800
Mailing Address - Fax:208-287-5609
Practice Address - Street 1:1720 N WESTGATE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7164
Practice Address - Country:US
Practice Address - Phone:208-501-3896
Practice Address - Fax:208-334-0812
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5225101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1265565477Medicaid