Provider Demographics
NPI:1104006543
Name:DRAKE DONES, TAMMIE R (PHD)
Entity type:Individual
Prefix:DR
First Name:TAMMIE
Middle Name:R
Last Name:DRAKE DONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TAMMIE
Other - Middle Name:R
Other - Last Name:DONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5101 E US HIGHWAY 36 STE 100
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6646
Mailing Address - Country:US
Mailing Address - Phone:888-714-1927
Mailing Address - Fax:317-745-9565
Practice Address - Street 1:5638 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5042
Practice Address - Country:US
Practice Address - Phone:888-714-1927
Practice Address - Fax:317-745-9565
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041559A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN210870007OtherMEDICARE PTAN