Provider Demographics
NPI:1407075195
Name:DRAKE, PATRICIA EVELYN (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:EVELYN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 SHELL DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3773
Mailing Address - Country:US
Mailing Address - Phone:530-941-9524
Mailing Address - Fax:
Practice Address - Street 1:457 SHELL DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3773
Practice Address - Country:US
Practice Address - Phone:530-941-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12016103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical