Individual
DR. MICHAEL A DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY D HSPP
Contact information
Practice address
121 BUNTIN ST STE 1, VINCENNES, IN 47591-1320
(812) 885-2718
(812) 885-2727
Mailing address
515 BAYOU ST, VINCENNES, IN 47591-1034
(812) 886-6800
(812) 886-6809
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040859A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000188318
ANTHEM
IN
05
—
200082820
—
IN
Enumeration date
12/28/2005
Last updated
12/29/2017
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