Provider Demographics
NPI:1043221096
Name:WRIGHT, STEPHEN LANCE (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LANCE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1250
Mailing Address - Country:US
Mailing Address - Phone:850-222-3045
Mailing Address - Fax:850-521-3422
Practice Address - Street 1:312 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1250
Practice Address - Country:US
Practice Address - Phone:850-222-3045
Practice Address - Fax:850-521-3422
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004349103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73636OtherBCBS
FL73636OtherBCBS