Provider Demographics
NPI:1083743702
Name:WRIGHT, TANA J (LCSW)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-1657
Mailing Address - Country:US
Mailing Address - Phone:502-365-0838
Mailing Address - Fax:502-371-0760
Practice Address - Street 1:3038 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2195
Practice Address - Country:US
Practice Address - Phone:502-365-0838
Practice Address - Fax:502-371-0760
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34651041C0700X
KY5190104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100161110Medicaid
KY7100161110Medicaid
KYK016612Medicare PIN
KYK016610Medicare PIN
KYK016614Medicare PIN
KYK016613Medicare PIN
KYK016615Medicare PIN