Glen S Drake, MA
Individual provider Active NPI Marriage & Family Therapist · Harrison, ID
NPI 1790815876 · NPPES record last updated May 1, 2025
Key facts
- NPI
- 1790815876
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- LMFT6888 (ID)
- Practice address
- 15050 E Sunset Shores Cir
Harrison, ID 83833-8807 - Phone
- (559) 731-3727
- NPI assigned
- Mar 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT6888 | ID | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT6888 | ID | Yes |
Addresses
Primary practice location
15050 E Sunset Shores Cir
Harrison, ID 83833-8807
Mailing address
15050 E Sunset Shores Cir
Harrison, ID 83833-8807
Phone (559) 731-3727
Other providers in Harrison, ID
- Paul Edward Berger
- Harrison Community Ambulance
- Kootenai School District
- Partners in the Imaging Enterprise, LLC
- Virginia Ross
- Derek James Smith
All providers in Harrison, ID · Marriage & Family Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.