Provider Demographics
NPI:1104286236
Name:DRAKE, SHELLI
Entity type:Individual
Prefix:
First Name:SHELLI
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 WHITTEN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-3035
Mailing Address - Country:US
Mailing Address - Phone:207-621-6760
Mailing Address - Fax:207-621-6764
Practice Address - Street 1:276 WHITTEN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-3035
Practice Address - Country:US
Practice Address - Phone:207-621-6760
Practice Address - Fax:207-621-6764
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst