Provider Demographics
NPI:1316790975
Name:DAKE, CLORINDA (MFTC)
Entity type:Individual
Prefix:
First Name:CLORINDA
Middle Name:
Last Name:DAKE
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 ROLLING ROCK PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2874
Mailing Address - Country:US
Mailing Address - Phone:719-994-8638
Mailing Address - Fax:
Practice Address - Street 1:613 ROLLING ROCK PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2874
Practice Address - Country:US
Practice Address - Phone:719-994-8638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014261106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist