Provider Demographics
NPI:1174744080
Name:DRAKE, TERRI J (MA)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:J
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SOQUEL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2347
Mailing Address - Country:US
Mailing Address - Phone:831-469-3200
Mailing Address - Fax:831-477-1575
Practice Address - Street 1:313 SOQUEL AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2347
Practice Address - Country:US
Practice Address - Phone:831-469-3200
Practice Address - Fax:831-477-1575
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist