Active NPI
Jessica June Drake
- Psychologist
- Plymouth, MI
National Provider Identifier
1255856142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6361007695
- Practice address
- 595 Forest Ave
Plymouth, MI 48170-1775 - Phone
- (605) 759-4385
- NPI assigned
- Aug 11, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | |||
| Psychologist | 103T00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychologist | 103T00000X | 6361007695 | MI | Primary |
Addresses
Primary practice location
595 Forest Ave
Plymouth, MI 48170-1775
Mailing address
9004 Rockland
Redford, MI 48239-1888
Phone (605) 759-4385
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6361007695 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellness Counseling L.L.C. | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682035200000",
"number": "1255856142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9004 ROCKLAND",
"city": "REDFORD",
"state": "MI",
"postal_code": "482391888",
"telephone_number": "605-759-4385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "595 FOREST AVE",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481701775",
"telephone_number": "605-759-4385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAKE",
"first_name": "JESSICA",
"middle_name": "JUNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-11",
"last_updated": "2023-04-21",
"certification_date": "2023-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6361007695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.