Provider Demographics
NPI:1053727909
Name:DRAKE, ROBERT S (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:DRAKE
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 N DALE MABRY HWY
Mailing Address - Street 2:# 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3286
Mailing Address - Country:US
Mailing Address - Phone:813-368-9788
Mailing Address - Fax:
Practice Address - Street 1:7825 N DALE MABRY HWY
Practice Address - Street 2:# 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3286
Practice Address - Country:US
Practice Address - Phone:813-368-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH7324OtherMEDICAL LICENSE