Organization
LAKE COUNTRY THERAPIST
Active
Other names
Lake Country Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE DRAKE LCSW (OWNER)
(414) 405-5067
Entity
Organization
Contact information
Practice address
354 COTTONWOOD AVE STE C, HARTLAND, WI 53029-2011
(262) 290-3163
Mailing address
N8263 WOODY LN, IXONIA, WI 53036
(414) 405-5067
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780223073
—
WI
Enumeration date
02/18/2022
Last updated
04/06/2022
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